Claims Resolution Specialist
Company: Zinnia Health
Location: Newport Beach
Posted on: May 20, 2023
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Job Description:
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Job Type
Full-time
Description
JOB PURPOSE: The Claims Resolution Specialist will be able to
promptly follow up on the status of claims as well as resolve any
issues or denials. They will be well versed in the ability to
verify benefits as well as attempt an appeals process.
Job Duties and Responsibilities1. Follow Zinnia Health's policies
and procedures.2. Ability to complete verification of benefits with
health insurance plans for both in and out-of-network benefits.3.
Following up on and providing claim status.4. Following up on and
communicating actions that need to be taken to adjudicate claims,
including the ability to properly correct claims.5. Updating A/R6.
Managing spreadsheets for reporting and advanced ability on
Excel.7. Ability to well navigate in CMD and document all
correspondence in CMD.8. Ability to reconcile claims in CMD and
apply payments and credits to accounts.9. Types and performs data
entry as needed.10. Answers phone calls and maintains
professionalism with patients and insurance companies.11. Assists
staff and clients with scheduling concerns or conflicts.12. Reads
and routes incoming mail.13. Conducts research, and compiles and
types statistical reports.14. Makes copies of correspondence or
other printed materials and be able to interpret explanations of
payments and benefits.15. Prepares outgoing mail and
correspondence, including e-mail and faxes.16. Perform a high
volume of collection calls and/or correspondence in a fast-paced,
goal-oriented collections department.17. Ability to renegotiate
claim payments and file appeals when necessary.18. Ability to
recognize billing errors and correct them.19. Ability to reprocess
claims for various denial reasons.
Expectations1. DEPENDABILITY - Employees can be counted on to
complete assigned tasks in a timely manner with little supervision.
Accepts responsibility when necessary to see that the job gets
done.2. ATTENDANCE AND PUNCTUALITY - Is prompt and on time for
work, assignments, and meetings. Notifies supervisor prior to
lateness or absence. Understands that excess absences pose a
hardship on other employees.3. JOB SKILLS AND KNOWLEDGE - Employee
completes all insurance-related documents and correspondence for
any assigned clients in a timely manner. The employee has knowledge
of insurance terminology and the billing cycle process.4. QUANTITY
AND QUALITY OF WORK - Cares about the quality and accuracy of work
being produced. Accepts responsibility for completing job tasks.
Uses time productively and efficiently.5. ATTITUDE - Demonstrates a
cooperative, positive, and enthusiastic attitude toward fellow
employees, clients and outside parties. Maintains a positive
attitude in carrying out assignments and is helpful and courteous
to fellow employees.6. CONFIDENTIALITY - Compliant with all HIPAA
policies and procedures.7. COMMUNICATION SKILLS-Is effective in
written and oral expression. Demonstrates proper telephone
etiquette and able to communicate easily with clients, co-workers,
and outside parties in an appropriate manner. Relates to clients
and co-workers in a respectful and professional manner.8. CONDUCT -
Conducts one's self in a manner consistent with the agency's code
of ethics and code of conduct. Shows professionalism in an office
setting.9. FLEXIBILITY / HANDLING EMERGENCIES - Responds well to
changing situations or routines. Handles crisis situation calmly
and professionally.
CompetenciesTo perform the job successfully, an individual should
demonstrate the following competencies to perform the essential
functions of this position.* Analytical-the individual synthesizes
complex or diverse information.* Problem-solving-the individual
identifies and resolves problems in a timely manner and gathers and
analyzes information skillfully.* Oral communication-the individual
speaks clearly and persuasively in positive or negative situations,
demonstrates group presentation skills, and conducts productive
meetings* Delegation-the individual delegates work assignments,
gives authority to work independently, sets expectations, and
monitors delegated activities.* Leadership-the individual inspires
and motivates others to perform well and accepts feedback from
others.* Quality management-the individual looks for ways to
improve and promote quality and demonstrates accuracy and
thoroughness.* Judgment - the individual displays willingness to
make decisions, exhibits sound and accurate judgment and makes
timely decisions.* Planning/organizing-the individual prioritizes
and plans work activities, uses time efficiently, and develops
realistic action plans.Safety and security-the individual observes
safety and security procedures and uses equipment and materials
properly.Work Environment CharacteristicsThe work environment
characteristics described here are representative of those an
employee encounter while performing the essential functions of this
job. Reasonable accommodations may be made to enable individuals
with disabilities to perform the essential functions.* Noise Level
- usually quiet* Physical Demands - the employee is frequently
required to sit; the employee must occasionally lift and/or move up
to 25 pounds
Requirements
Minimum QualificationsEducation / Experience* Has a high school
diploma or GED* Previous experience working with insurance billing
for facility preferred.Certificates and Licenses* No certificate or
license is requiredKnowledge* Exceptional attention to detail and
an eye for spotting errors and discrepancies.* Strong communication
and customer service skills with the ability to see issues through
to resolution.* Intermediate to advanced levels of skills in
Microsoft Office and a proven aptitude for computers.* Strong
understanding of current ICD-10, CPT and HCPCS coding
practices.
Salary Description
$17-$22 hourly
Keywords: Zinnia Health, Newport Beach , Claims Resolution Specialist, Other , Newport Beach, California
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