Claims Denial Resolution Specialist - HealthDrive

HealthDrive is seeking a professional and organized full-time Claims Denial Resolution Specialist with outstanding communication and organizational skills. The Claims Denial Resolution Specialist is responsible for the resolution of issues impacting the collection of unpaid, denied, and incorrectly paid medical and dental claims from insurances, including Medicare, Medicare Replacement plans/Medicare Supplemental plans, Medicaid, BC/BS, and Managed Care plans in numerous states.

We are conveniently located off Route 9 in Framingham, Massachusetts, close to routes 90 and 495 in a spacious modern office with a workout center available right in the building!

What's in it for you: PPO Medical, Dental, and Vision Insurance, 401(k) + Company match, Paid Time Off, hybrid schedule opportunity, monthly meal program, Verizon Wireless, Dell, and other employee discounts, profit sharing, and employee referral bonuses.

HealthDrive delivers on-site dentistry, optometry, podiatry, audiology, behavioral health, and primary care services to residents in long-term care, skilled nursing, and assisted living facilities. Each specialty offered by HealthDrive is one that directly impacts the quality of daily life for the deserving residents we serve. HealthDrive connects patients in need of vital healthcare to doctors committed to dignity and excellence.

HealthDrive is a place where everyone can grow and training is provided. Join our diverse team today!

• Reduce outstanding Medical/Dental Accounts Receivable balances due from various insurance plans through focused daily efforts to increase cash collections and reduce bad debt
• Identify, investigate and follow up with insurance plans to expedite resolution of denied and/or unpaid claims in order to obtain payment in a timely manner
• Submit corrected claims and appeals within the specific insurance plan’s timely filing/appeal limits
• Become the expert on the billing and claim requirements for assigned insurance plans
• Utilize insurance plan website (s) to check claim status, submit online appeals, submit Explanation of Benefits (EOB’s) required for processing secondary/tertiary claims
• Identify and communicate denial and payment trends by insurance plan, review and resolve denials by reason code
• Meet assigned daily productivity objectives for review and resolution of assigned accounts
• Initiate claim adjustments and resubmission of claims to insurance plans, facility or responsible party
• Work professionally and cooperatively with facilities, responsible parties, insurance carriers and all internal and external customers
• Assist with other duties and/or projects in order to meet business needs/objectives

• Knowledge of Medicare, Medicaid and other third-party insurance plans billing practices and regulations
• Working knowledge of adjustment and denial reason codes from Electronic Remittance Advices (ERA files) and from paper Explanation of benefits (EOB’s), CPT and ICD10 codes
• Excellent interpersonal and communication skills, outgoing personality with a professional demeanor and positive attitude
• Commitment to excellence with high quality standards for providing highest quality service to customers
• Strong time management and organizational skills; ability to effectively multitask and meet deadlines
• Excellent attention to detail with exceptional follow-up, problem-solving and analytical skills
• Exhibit courteous, compassionate and respectful treatment of internal and external customers.
• Self-motivated, quick learner who works well independently and, in a team setting
• Strong work ethic with exemplary attendance record
• Knowledge of HIPAA regulations and patient privacy rules
• Strong computer skills, proficiency with Excel, Outlook and Word and Medical Billing Software

Education:

• High school diploma required; Associate’s degree preferred
• Prefer 3-5 years’ experience in performing daily review and follow up on unpaid and denied medical claims from insurance plans (Medicare, Medicaid, BCBS and various other insurance plans).
• Prefer candidates with experience in healthcare billing, collections and eligibility/insurance verification

Physical Requirements:

• Ability to sit and process data in computer for long periods of time.
• Ability to use office equipment such as computer, phone, fax, and copier.