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Claims Resolution Manager Jobs in Nevada (NOW HIRING)

Trice Healthcare

Coding Payment Resolution Spec

Carson City, NV · On-site

$18.25 - $23.50/hr

Coding Payment Resolution Specialist Responsible for reviewing all post-billed denials (inclusive ... managed care organization or other health care financial service setting, performing medical claims ...

Fortis Construction

EHS Manager

Reno, NV · On-site

$82K - $112K/yr

Partner on all claims resolution efforts (Owner and Subcontractor). * Tracks, logs, and notifies client, Fortis management, project team and relevant government or insurance agencies of EHS successes ...

Renown Health

Sr Insurance and Claims Specialist

Reno, NV · On-site

$22.16 - $31.03/hr

Position Purpose The Senior Insurance and Claims Specialist is responsible for compliant billing ... resolution. • Identify trends in payor non-compliance and inform management if not able to ...

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Claims Resolution Manager information

What is the difference between Claims Resolution Manager vs Claims Adjuster?

AspectClaims Resolution ManagerClaims Adjuster
CredentialsInsurance licenses, sometimes management certificationsInsurance licenses, specific to claims handling
Work EnvironmentSupervisory roles, team coordinationField or office-based, claims investigation
Employer & Industry UsageInsurance companies, claims departmentsInsurance companies, third-party administrators
Search & Comparison IntentUnderstanding managerial roles in claimsDetails about claims handling and investigation

The Claims Resolution Manager oversees claims processes and manages teams, focusing on strategy and resolution. Claims Adjusters handle the investigation and evaluation of individual claims. While both roles require insurance licenses, the manager's role is more supervisory, whereas the adjuster is more hands-on with claims investigation.

Is claims processing a stressful job?

Claims resolution managers often handle complex cases and tight deadlines, which can contribute to workplace stress. The job requires strong organizational skills and attention to detail, but stress levels vary depending on workload and company support systems.

What does a claims resolution manager do?

A Claims Resolution Manager oversees the process of handling insurance claims from initiation to closure, ensuring that claims are resolved efficiently and fairly. They investigate claim details, coordinate with adjusters, clients, and third parties, and work to resolve disputes or issues that may arise during the claims process. Their goal is to ensure compliance with company policies and legal regulations while optimizing customer satisfaction and minimizing losses for the organization.

What are the key skills and qualifications needed to thrive as a claims resolution manager, and why are they important?

To thrive as a Claims Resolution Manager, you need a solid background in insurance claims processing, dispute resolution, and regulatory compliance, often supported by a bachelor's degree in business, finance, or a related field. Familiarity with claims management software, CRM tools, and relevant certifications such as AIC or CPCU is common. Strong analytical thinking, negotiation skills, and effective communication are crucial soft skills for managing complex cases and guiding teams. These abilities ensure efficient claims handling, customer satisfaction, and minimized financial risk for the organization.

How much do claims resolution managers make in the US?

Claims resolution managers in the US typically earn a median annual salary of around $70,000 to $90,000, depending on experience, location, and the size of the employer. Salaries can vary based on industry, certifications, and the complexity of claims handled.

What are the primary challenges a claims resolution manager faces when balancing client expectations with policy limitations?

Claims Resolution Managers often navigate the delicate balance between meeting client expectations and adhering to insurance policy terms. One common challenge is communicating complex policy details to clients who may be experiencing stress or frustration. Additionally, managers must ensure timely and fair claims processing while coordinating with adjusters, legal teams, and external vendors. Success in this role requires strong negotiation skills, empathy, and a thorough understanding of regulatory and company guidelines.
Claims Resolution Manager jobs near you

Coding Payment Resolution Spec

Trice Healthcare

Carson City, NV • On-site

$18.25 - $23.50/hr

Other

Re-posted 5 days ago

Job description

Coding Payment Resolution Specialist

Responsible for reviewing all post-billed denials (inclusive of coding-related denials) for coding accuracy and appealing them based upon coding expertise and judgment within the Hospital and/or Medical Group revenue operations of a Patient Business Services center.

Serves as part of a team of coding payment resolution colleagues at a PBS location responsible for identifying and determining root causes of denials.

Responsible for leveraging coding knowledge and standard procedures to track appeals through first, second, and subsequent levels, and ensuring timely filing of appeals as required by payers. In addition to promoting departmental awareness of coding best practices.

This position reports directly to the Supervisor Clinical/Coding Payment Resolution.

Essential Functions

  • Knows, understands, incorporates, and demonstrates the Client Mission, Vision, and Values in behaviors, practices, and decisions.
  • Provides detailed understanding or aptitude for resolving denials based on ICD-10-CM diagnosis codes, ICD-10-PCS codes, and CPT-4 procedural codes for UB-04 outpatient or inpatient claims, or other coding reasons and processing charge corrections based on medical record reviews, contracts, regulations as directed by the Supervisor Clinical / Coding Payment Resolution.
  • Interprets data, draws conclusions, and reviews findings with all level of Payment Resolution Specialist for further review.
  • Takes initiative to continuously learn all aspects of Payment Resolution Specialist role to support progressive responsibility.
  • Other duties as needed and assigned by the Supervisor Clinical / Coding Payment Resolution.
  • Maintains a working knowledge of applicable Federal, State and local laws/regulations; the Client and Compliance Program and Code of Conduct; as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical and professional behavior.

Minimum Qualifications

  • High school diploma or Associate degree in Accounting or Business Administration or related field, and a minimum of four (4) years' experience within a hospital or clinic environment, a health insurance company, managed care organization or other health care financial service setting, performing medical claims processing, financial counseling, financial clearance, accounting or customer service activities or an equivalent combination of education and experience. Experience in a complex, multi-site environment preferred.
  • Must possess comprehensive knowledge of professional/physician diagnostic and procedural coding, as normally obtained through a coding certificate program and least one (1) year of physician/professional or hospital outpatient coding experience or minimum of two (2) years of relevant hospital inpatient coding experience including DRG assignment.
  • Must be a Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), or coding credential of a Certified Coding Specialist (CCS) or Certified Professional Coder (CPC).
  • Must have experience with National Correct Coding Initiative edits (NCCI), National Coverage Determinations (NCD), Local Coverage Determinations (LCD), and Outpatient coding guidelines for official coding and reporting.
  • Possesses detailed understanding of principles, methods, and techniques related to compliant healthcare billing/collections.
  • Possesses expertise in medical terminology, disease processes, patient health record content and the medical record coding process.
  • Must be comfortable operating in a collaborative, shared leadership environment.
  • Must possess a personal presence that is characterized by a sense of honesty, integrity, and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals, and values of Client.

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