Claims Resolution Specialist

Job Purpose

The claim resolution specialist resolves all unpaid insurance claims by researching all incoming denials.  The specialist will monitor the clearinghouse and worklist within the EMR to proactively find and resolve unpaid claims.  They will manage all incoming mail/email correspondence from Insurance companies and respond to the requests in a timely manner.  The specialist will create a monthly patient statement. They will monitor A/R and work A/R balance due by patient and insurance.  The Specialist ensures that billing operations are accurate and efficient and that they conform to the generally accepted principles in the field. They should have excellent communication skills to gather information for other departments within the facility.

Essential Duties & Responsibilities 

Duty

Percent of Time

Follows-up on commercial insurance denials, non-payments, incorrect payments, and patient private balances for Inpatient and Outpatient Claims

25%

Follows-up on Oklahoma Medicaid denials, non-payments, incorrect payments for Inpatient and Outpatient claims.

45%

Updates Inpatient and Outpatient Demographic, Insurance, Authorization, Guarantors, and any other information required for a correct and complete claim.

5%

Evaluates A/R reports to prevent timely filing and loss of revenue from denial or missed opportunities. 

15%

Communicate with Referral, Authorization and Registration Department to get information needed for claim payments.

5%

Other duties as assigned.

5%

Qualifications 

Education:

High School Diploma or equivalent

Experience:

1+ years of experience in outpatient and inpatient Commercial Insurance and Medicaid claim denial management.

1+ years of experience in a healthcare environment preferred.  ICD-10 and CPT-4 coding experience preferred.

1+ years of Meditech experience preferred.

Proficient at MS Excel and MS Word Preferred.

Our work begins where we are all equal - at the heart.

Bethany Children’s Health Center is an innovative leader in the field of pediatric rehabilitation and 24-hour complex care. The hospital offers inpatient and outpatient services for children (ages 0-21) and is the only inpatient pediatric rehabilitation facility in Oklahoma. Our CARF accredited multidisciplinary team works with patients and their families to maximize the patient’s physical and cognitive potential, and ensure the family has the training and resources needed for a smooth transition from hospital to home. In 2021, the hospital received accreditation from The Healthcare Facilities Accreditation Program (HFAP), the nation’s original independent accreditation program recognized by the Centers for Medicare and Medicaid Services (CMS). This distinction confirms that Bethany Children’s Health Center is providing high quality patient care as determined by an external process of evaluation.

In order to maximize the potential of every child, we must maximize the potential of every employee. We are committed to providing staff with the physical, emotional, spiritual, financial and mental resources necessary to achieve their potential and meet our standards of excellence. BCHC offers competitive compensation, benefits, state-of-the-art equip