Claims Resolution Specialist II

About the role

Central Georgia Cancer Care is hiring a Claims Resolution Specialist II to review medical insurance claims and obtain appropriate payment through defined processes. The role also resolves incoming inquiries, denials and correspondence from insurers and other parties, and contacts insurance carriers to research and respond to open account balances. The position is listed as on-site.

Key responsibilities

• Respond to patient and office inquiries about outstanding balances, payments received, allowable charges, assignment of benefits and other insurance questions.
• Manage insurance reviews and denials by providing supporting documentation for appeals and follow up on claims until payment is received.
• Coordinate with office personnel and doctors as needed, and report consistent claim denials or payer issues to the team lead.
• Follow up on correspondence, transfer balances to patient responsibility per SOP, bill secondary insurance and document collection activity in Onco EMR, Centricity and Unity.
• Contact patients to correct insurance information, attend payer meetings and training, and keep work areas and records tidy.
• Maintain confidentiality of patient and employee information under HIPAA and company policy, and comply with federal and state laws and company policies.

Required profile

• High school diploma or GED; at least 1 year of work experience in the medical field.
• Experience in medical billing and/or collections.
• Knowledge of medical oncology/hematology and/or radiation, pathology, radiology, pumps and specialties.
• Ability to work independently and in a team, with excellent communication skills.
• Completion of 6 CEUs annually.

Required skills

• Insurance carrier billing and reimbursement, medical terminology, ICD-9, ICD-10 and CPT codes, and Explanation of Benefits (EOB).
• Preferred: EMR and GE Centricity Practice Management software experience.