Claims Resolution Specialist

Job Purpose

The claims 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

30%

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

30%

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

15%

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%

Education

Qualifications

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 equipment and wellness programs. Opportunities for professional growth include in-service training, leadership development, tuition reimbursement and scholarships.

• Due to the nature of our pediatric services, this organization’s positions are classified as safety-sensitive roles. Under the Oklahoma Medical Marijuana Use and Patient Protection Act (OMMA), a safety sensitive position is defined as any job that includes tasks or duties that the employer believes could affect the safety and health of the employee performing the task or others. This statute allows Bethany Children’s Health Center to refuse to hire an applicant or discharge an employee in a safety-sensitive position, who tests positive for marijuana even if the applicant or employee holds a valid Oklahoma medical marijuana license.