Appeal Resolution Specialist jobs in New Britain, CT

Women's Health CT is currently seeking a Full-time, Posting Resolution Specialist at the Corporate Business Office in Rocky Hill, CT!

Position: Positing Resolution Specialist
Location: Women's Health Connecticut
Address: 175 Capital Blvd. Rocky Hill, CT 06067
Employment: Full-time
Working Arrangement: Hybrid, two-three days on-site
Schedule: Monday- Friday

Position Summary: The Positing Resolution Specialist will process, research and resolve all tasks and functions associated with payments, adjustments and refunds that have been posted by third party, internal and external customers.

Position duties and responsibilities:

• Manage multiple priorities, monitoring multiple dashboards to identify work and remain current
• Perform month end close process within the practice management system (if applicable)
• Post payments in practice management system when needed
• Retrieve remittance advice from payers and upload to practice management system as needed
• Submit and manage cases/requests for corrections within practice management system
• Manage refund submissions to Finance
• Investigate, resolve and process returned refund checks in preparation for annual escheatment filing
• Research and resolve unpostable items
• Provide trending analysis of data and recommend process changes or education to prevent ongoing issues
• Review patient account to ensure claim processed correctly and that refund is appropriate
• Follow customer specific protocols to apply patient credits timely and refunding when applicable
• Daily work within practice management system to reduce volume of pending refunds
• Contact insurance carrier to research payments and/or determine correct method of refund
• Utilize insurance websites to research claim statuses
• Run reports and communicate with management status of credits across all systems
• Evaluate all identified unallocated payments to guarantee proper settlement and or refund
• Respond to customer inquiries timely
• Provide training to customers where needed on posting related tasks
• Trend and communicate all issues to management
• Participate in proactive team efforts to achieve departmental and company goals
• Process credit card payments for legacy system
• Maintain and respect the confidentiality of PHI (Protected Health Information) in accordance with insurance collection guidelines, corporate policy and all HIPAA (Health Insurance Portability and Accountability Act) mandates.
• Other duties as assigned by management

Required Skills and Qualifications

• High School Diploma or GED
• Prior experience with medical insurance collections and/or payment posting and processing refunds
• Computer skills evidenced by proficiency and /or training with applicable software
• Strong Working knowledge of Microsoft Office Suite
• Ability to set priorities and meet established deadlines
• Excellent written and verbal communication skills
• Excellent customer service skills
• Knowledge of CPT and ICD coding helpful, but not necessary
• Good mathematical ability

Physical demands:

• Ability to remain seated for up to 8 hours per day.
• Ability to work in fast paced environment.

Qualified candidates are encouraged to apply to learn more about all the position has to offer!

The Job responsibilities provided are intended to be a summary of the job duties. In no instance should the duties, responsibilities, and requirements included in a job description constitute as being all-inclusive. The Company and authorized management personnel reserve the right to review, change, add and/or delete duties, responsibilities, and requirements on a job description as necessary.

Job Type: Full-time

Pay: $25.00 - $27.00 per hour

Expected hours: 40 per week

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• Monday to Friday

Experience:

• ICD-10: 1 year (Preferred)
• Medicaid: 1 year (Preferred)
• Account analysis: 1 year (Preferred)

Ability to Commute:

• Rocky Hill, CT 06067 (Required)

Ability to Relocate:

• Rocky Hill, CT 06067: Relocate before starting work (Required)

Work Location: Hybrid remote in Rocky Hill, CT 06067