Claims Resolution Specialist

Claims Resolution Specialist Department: RCS Claims Direct Reports To: Revenue Cycle Supervisor Location: Remote in the following states: NE, TX, KS, AR, AZ Employment Type: Full-Time, Non-Exempt About TELCOR Founded in 1995 and headquartered in Lincoln, Nebraska with an office in San Francisco, California, TELCOR is a proven leader in healthcare software, delivering Point of Care (POC) middleware, Revenue Cycle Management (RCM) software, RCM managed billing services, and AI-driven solutions to hospitals, health systems, and independent laboratories nationwide.

TELCOR is Great Place to Work Certified®, and our core values — integrity, innovation, dedication, acceptance, passion, and collaboration — guide how we build products and work with one another.

Job Summary

The TRCS Claims Resolution Specialist is responsible for performing revenue cycle tasks for TELCOR Revenue Cycle Service customers. The Claims Resolution Specialist responsibilities include; client billing, insurance billing, patient billing, and accounts receivable. In addition, the Claims Resolution Specialist will demonstrate expertise in RCM workflow, insurance policies and requirements including payer-specific policies and requirements, and industry knowledge.

Responsibilities

Claims Resolution Specialist

• Responsible for working claim rejections, payer rejections, and payer denials by performing analysis and investigation of individual scenarios while identifying commonalities or trends within current worklists or across future and past worklists in order to continuously improve quality, efficiency, and customer outcomes for TRCS Success
• Responsible for follow up and taking action by interpreting information, making determinations, applying knowledge, and executing appropriate next steps on payer rejections and denials in order to facilitate payment, balance transfers, or adjustments based on customer-specific and/or payer-specific requirements
• Responsible for follow-up on claims with no payer response after submission or resubmission
• Adhering and referring to the requirements in accordance with Standard Operating Procedures or Best Practices as documented or as verbalized from supervisors or other leadership
• Responsible for determining and knowing when to bill a patient and when to assign work back to the customer for review, feedback, or completion of next steps and taking appropriate action to keep the claim moving through the revenue cycle
• Responsible for escalating questions, errors, or setup changes to TRCS Revenue Cycle Supervisor in order to keep the claim moving through the revenue cycle and to produce accurate, timely, and quality work
• Responsible for follow up and taking appropriate next steps on claims with no payer response to facilitate payment or balance transfers to other responsible parties
• Demonstrate knowledge of CPT, HCPCs modifiers, ICD-10 codes, and EOB interpretation
• Demonstrate knowledge of payer requirements, clearinghouse portal navigation, and appropriate interpretation of information
• Meet with the TRCS team on a regular basis to discuss and identify issues, review team performance, participate in ongoing training and process development
• Enhance business line organization and success by accepting ownership for accomplishing new and different requests, exploring opportunities to add value to job accomplishments, and making recommendations on ways to improve
• Demonstrate basic knowledge of other team member functions such as Client Service Managers, System Administration, Claims Resolution Specialist II and Remittance Specialists in order to execute Claims Resolution Specialist I job functions with an understanding of how the entire revenue cycle is interconnected
• Meet performance expectations set forth by supervisors and leadership team
• Stay current on work assigned or delegated within timelines and timeframes established as standard expectations or as set forth by supervisors or other leadership
• Demonstrate the ability to think analytically and apply strategy to use of and interaction with the RCM application and other tools to be more efficient and effective
• Demonstrate fluent knowledge of the RCM application
• Demonstrate advanced payer and process knowledge
• Accurately and effectively serve as a resource to others for questions and direction when needed by demonstrating the ability to share skills and knowledge with others
• Claims Resolution Specialists may be placed in or assigned to areas of focus or specialization
• Responsible for follow-up on unpaid balances to obtain payment, and write, compile, and submit reconsiderations or appeal letters with supporting documentation as necessary.
• Additional duties may be assigned. Required Qualifications:
• Must be able to uphold confidentiality and comply with federal, state, and company policy, procedures, and regulations.
• Ability to effectively and professionally communicate, both in writing and verbally with tact, diplomacy, and respect for others.
• Must be able to work independently, and with team to achieve individual and team goals.
• Must be able to apply critical thinking and appropriate discernment in all activities and job functions before taking action or initiating communication.
• Must possess creative thinking skills to develop, design, and create solutions.
• Must have strong computer skills and be able to leverage and navigate using technology to complete daily tasks (e.g. Excel, electronic documentation storage and retrieval, keyboarding and mouse navigation, email/outlook).
• Self-motivated, analytical, quick learner, organized, detail oriented, multi-tasker, resilient, self-disciplined in time management.
• Ability to demonstrate understanding of the structure, key issues, language, and the general billing or revenue cycle environment with an ability to discuss and explain current and emerging issues, including TELCOR products and services applicable to those needs.
• Must have a thorough understanding of Windows® operating system environments and Office tools; e.g., Word®, Excel® Preferred Qualifications:
• One or more years of healthcare billing or revenue cycle experience (laboratory billing a plus) or medical coding education preferred, but not required. This is a remote role, we are currently only hiring in one of the following states: NE, TX, KS, AR, AZ TELCOR is an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status, or any other characteristic protected by law. All trademarks, service marks, trade names, trade dress, product names and logos appearing herein are the property of their respective owners. Microsoft, Windows, Crystal Reports and SQL Server are either registered trademarks or trademarks of Microsoft Corporation in the United States and/or other countries.