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Resolution Manager Jobs in West Springfield, MA (NOW HIRING)

Trice Healthcare

Coding Payment Resolution Spec

Hartford, CT · On-site

$19 - $24.25/hr

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

ENFRA LLC

Project Executive

Hartford, CT · On-site

Actively monitors and manages the status and timeliness resolution of Change Management on the project(s). * Actively monitors and manages the status and timeliness of issuing, negotiating and ...

ENFRA LLC

Project Executive

Hartford, CT

Actively monitors and manages the status and timeliness resolution of Change Management on the project(s). * Actively monitors and manages the status and timeliness of issuing, negotiating and ...

ENFRA LLC

Project Executive

Hartford, CT · On-site

Actively monitors and manages the status and timeliness resolution of Change Management on the project(s). * Actively monitors and manages the status and timeliness of issuing, negotiating and ...

ENFRA LLC

Project Executive

Hartford, CT

Actively monitors and manages the status and timeliness resolution of Change Management on the project(s). * Actively monitors and manages the status and timeliness of issuing, negotiating and ...

Crawford & Company

RN Case Manager

Hartford, CT · On-site

Excellent analytical and customer service skills to facilitate the resolution of case management ... problems. * Basic computer skills including working knowledge of Microsoft Office products and ...

Consigli Construction

Project Manager

Hartford, CT · On-site

$52K - $152K/yr

... resolution of all critical issues with a focus on quality, cost, and schedule. Provide ... Manage the timely close out documentation process for assembly and submission to the Design Team ...

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Resolution Manager information

How does a resolution manager typically collaborate with other departments to resolve complex issues?

Resolution Managers frequently work cross-functionally, partnering with teams such as customer service, operations, legal, and IT to address and resolve challenging cases or disputes. Effective communication and coordination are essential, as Resolution Managers often facilitate meetings, gather input from multiple stakeholders, and ensure everyone is aligned on the resolution approach. This collaborative process not only helps in resolving issues efficiently but also provides broader insight into recurring problems, allowing the company to implement long-term process improvements.

What are the key skills and qualifications needed to thrive as a resolution manager?

To thrive as a Resolution Manager, you need strong problem-solving abilities, conflict resolution skills, and a background in business administration or a related field. Familiarity with case management software, CRM platforms, and sometimes certifications in mediation or dispute resolution are typically required. Exceptional communication, negotiation, and emotional intelligence help you manage stakeholder expectations and diffuse tense situations. These skills are crucial for efficiently resolving disputes, maintaining client satisfaction, and protecting organizational reputation.

What is the difference between Resolution Manager vs Customer Service Manager?

AspectResolution ManagerCustomer Service Manager
Primary FocusResolving complex issues and disputes efficientlyOverseeing customer service teams and satisfaction
Required SkillsProblem-solving, conflict resolution, technical knowledgeLeadership, communication, customer relationship management
Work EnvironmentOperations, support centers, client-facing rolesCall centers, retail, service industries
CertificationsRelevant industry certifications, conflict resolution trainingCustomer service certifications, management training

While both roles focus on customer interactions, the Resolution Manager specializes in resolving complex issues and disputes, often requiring technical or specialized knowledge. The Customer Service Manager oversees overall customer satisfaction and team management. Understanding these differences helps in choosing the right career path or hiring the appropriate professional for specific needs.

What cities near West Springfield, MA are hiring for Resolution Manager jobs? Cities near West Springfield, MA with the most Resolution Manager job openings:
Resolution Manager jobs near you

Coding Payment Resolution Spec

Trice Healthcare

Hartford, CT • On-site

$19 - $24.25/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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