Claims Resolution Specialist
Company: Zinnia Health
Location: Newport Beach
Posted on: May 20, 2023
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
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.
Keywords: Zinnia Health, Newport Beach , Claims Resolution Specialist, Other , Newport Beach, California
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