Claims Resolution Specialist in Brentwood, TN at Parallon

Date Posted: 4/27/2018

Job Snapshot

Job Description

Parallon believes that organizations that continuously learn and improve will thrive. That's why, after more than a decade, Parallon remains dedicated to helping hospitals and hospital systems operate knowledgeably, intelligently, effectively and efficiently in the rapidly evolving healthcare marketplace, today and in the future. 

As one of the healthcare industry's leading providers of business and operational services, Parallon is uniquely equipped to provide a broad spectrum of customized services in the areas of revenue cycle, purchasing, supply chain, technology, workforce management and consulting. 

Parallon's purpose is simple. We serve and enable those who care for and improve human life in their communities. 

Clinical Denials Claims Resolution Specialist 

Job Summary – The Clinical Denials Claims Resolution Specialist is responsible for applying fundamental knowledge of coding and payor requirements as it relates to researching, analyzing, and resolving outstanding clinical denials and insurance claims. This job requires regular outreach to payors and Practices.

Supervisor – Clinical Denials Manager 

Supervises – None 

Duties (included but not limited to) 
Triage incoming inventory, validating appeal criteria is met in compliance with departmental policies and procedures, Compose technical denial arguments for reconsideration, including both written and telephonically, Overcome objections that prevent payment of the claim and gain commitment for payment through concise and effective appeal argument, Identify problem accounts/processes/trends and escalate as appropriate, Utilize effective documentation standards that support a strong historical record of actions taken on the account, Post denials, post or correct contractual adjustments, and post other non-cash related Explanation of Benefits (EOB) information, Update patient accounts as appropriate, Submit uncollectible claims for adjustment timely and correctly, Resolve claims impacted by payor recoupments, refunds, and posting errors, Meet and maintain established departmental performance metrics for production and quality, Maintain working knowledge of workflow, systems, and tools used in the department, Practice and adhere to the “Code of Conduct” philosophy and “Mission and Value Statement”, Other duties as assigned 

Knowledge, Skills, and Abilities 

Communication - communicates clearly and concisely, verbally and in writing, utilizing proper punctuation and correct spelling 
Customer orientation - establishes and maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations 
Interpersonal skills - able to work effectively with other employees, patients, and external parties 
PC skills - demonstrates proficiency in Microsoft Office applications and others as required 
Policies & Procedures - demonstrates knowledge and understanding of organizational policies, procedures, and systems 
Basic skills - demonstrates ability to organize, perform and track multiple tasks accurately in short timeframes; able to work quickly and accurately in a fast-paced environment while managing multiple demands; able to work both independently and collaboratively as a team player; demonstrates adaptability, analytical and problem solving skills, and attention to detail; and able to perform basic mathematical calculations, balance and reconcile figures, and transcribe accurately 

High school diploma or GED required 

Experience -  Minimum two years claims experience preferred, such as accounts receivable follow-up, insurance follow-up, insurance posting, professional medical/billing, medical payment posting, and/or cash application. Prior experience reading and interpreting Explanation of Benefits (EOB) required

Certificate/License -  None

Physical Demands / Working Conditions– Requires prolonged sitting/standing, some bending, stooping, walking and stretching. Requires eye-hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator and other office equipment. Requires normal range of hearing and eyesight to record, prepare and communicate appropriate reports or other information. Requires lifting papers/boxes and pushing/pulling up to 25 pounds occasionally. Work is performed in an office environment or hospital setting. Work may be stressful at times. Contact may involve dealing with angry or upset people. Staff must remain flexible and available to provide staffing assistance for any/all disaster or emergency situations. 

OSHA Category– The normal work routine involves no exposure to blood, body fluids, or tissues (although situations can be imagined or hypothesized under which anyone, anywhere, might encounter potential exposure to body fluids). Persons who perform these duties are not called upon as part of their employment to perform or assist in emergency care or first aid, or to be potentially exposed in some other way.