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Resolution Specialist

RDG Filings
Salem, VA
  • Expired: over a month ago. Applications are no longer accepted.
Job Description

Our company is growing! We are seeking Resolution Specialist with knowledge in the healthcare field. The Resolution Specialist is responsible for financial settlements of disputed charges and obtaining fair and reasonable prices for our clients.

Research Data Group’s Beacon HCI division is designed to save corporate healthcare payers millions of dollars utilizing a proprietary software tool developed with years of research and knowledge of Federal Billing Guidelines and Regulations in the healthcare industry.

 

General duties

  • Conduct an analysis of all system documents related to claim review performed by analyst.
  • Navigate and utilize all systems effectively for both physician and facility review.
  • Research facility for documentation and sources or any other information to support our dispute.
  • Develop a strategic plan to initiate dialogue with the facility.
  • Resolve the non-compliant charge(s) with the facility.
  • Discuss any identified Corporate Integrity Agreements (CIA), Hospital Acquired Conditions (HAC) and/or fair and reasonable pricing.
  • Determine if there are repetitive CIA or HAC issues within a category.
  • Propose a confirmation agreement letter.
  • Enters clear and concise documentation into system(s), to include voice recording of conversations.
  • Submit documentation to Senior workflow manager for all resolutions and/or for any unfavorable appeals and reconsiderations for determination of next steps.
  • Scan signed confirmation agreement letter and/or appeal documentation into system(s).
  • Handle other settlement issues as needed.
  • Report and track all appeals received, assigned and completed.
  • Evaluate billing appropriateness, standard concepts, claim practices and claim procedures.
  • Interpret and understand health insurance appeals and provider dispute resolution processes, applicable clinical guidelines and health payer coverage policies to effectively prepare appeals.
  • Draft detailed appeal and refund letters.
  • Submit and track actions on appeals letters, reconsiderations and re-determination requests submitted to medical facilities.
  • Collaborate with Senior Workflow Manager on a case-by-case basis when necessary.
  • Collaborate with Senior Workflow Manager in identifying client objectives and specifications.
  • Comply and enforce HIPAA policies and procedures.
  • Update coding and billing guideline resources as needed.

Knowledge, Skills & Abilities

  • Knowledge of CMS rules and regulations and other billing guidelines
  • Exceptional attention to detail, excellent written and verbal skills, excellent organizational, analytical, and problem-solving skills
  • Capable of handling multiple projects in a fast paced, hyper-growth environment
  • Strong interpersonal and team building skills - ability to work with a diverse team and impart change across functional and business boundaries.

 Experience and Training

  • Certified Professional Coder is a plus
  • Two years of experience in healthcare billing, appeals, revenue cycle and/or healthcare compliance area
  • Two years of experience working in Microsoft Office

RDG Filings

Address

816 Roanoke Blvd

Salem, VA
USA

Industry

Business

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