Claims Resolution Specialist

Responsibilities

• Review errored and rejected claims in SSI
• Ensure patient demographics, insurance, coding, modifiers, units, and authorization requirements are complete before submission
• Submit claims electronically or via clearinghouse in a timely manner
• Monitor and resolve claims in error, hold, wait, and rejected statuses
• Maintain payer enrollment
• Validate claims against CMS billing guidelines, payer-specific requirements, and organizational policies
• Identify and elevate discrepancies to Billing QA, Coding, Patient Access, or the Manager
• Maintain assigned SSI work queues and work accounts daily
• Meet productivity and turnaround targets and prevent backlog accumulation
• Release claims within the established SLA, typically under 24 hours after readiness
• Identify trends in claim holds or delays and communicate recurring issues to leadership or the Revenue Cycle Analyst
• Collaborate with cross-functional teams to resolve claim submission barriers
• Maintain high accuracy and support clean claim rate goals
• Follow departmental workflows and documentation standards
• Maintain regular and predictable attendance
• Perform other essential duties as assigned

• High School Diploma or equivalent
• 2+ years of healthcare billing or revenue cycle experience
• Residency in Missouri or Kansas is required
• Patient Access / Registration experience preferred
• Experience working in an EHR system (MEDITECH preferred)
• Experience working in clearinghouse (SSI Preferred)
• Basic understanding of CPT, HCPCS, and ICD-10 coding
• Basic understanding of insurance billing processes
• Basic understanding of claim submission workflows
• Attention to detail and accuracy
• Time management and ability to meet deadlines
• Strong organizational skills
• Effective communication and teamwork
• Ability to follow standardized workflows
• Ability to sit and stand intermittently for 8 to 10 hours a day
• Ability to use standard office equipment, including the telephone and computer keyboard
• Ability to work under pressure while meeting near 100% accuracy and inflexible deadlines
• Manual/bi-manual dexterity, near vision, speech, and hearing
• Ability to lift and/or carry up to 40 lbs.
• Ability to occasionally walk on uneven surfaces

Demonstrates expertise in healthcare billing processes, including claim submission workflows and coding standards such as CPT, HCPCS, and ICD-10. Proven ability to maintain accuracy and meet productivity targets while collaborating with cross-functional teams to resolve claim issues.

• Healthcare Billing Experience
• Claim Submission Workflows
• CPT, HCPCS, ICD-10 Coding
• EHR System Experience
• Attention to Detail

• Claim Review
• Payer Enrollment
• Claims Validation
• Insurance Billing Processes
• Claims Monitoring
• Productivity Targets
• Documentation Standards
• Error Resolution
• Standardized Workflows
• Manual Dexterity

• Effective Communication
• Time Management
• Organizational Skills
• Teamwork
• Ability to Work Under Pressure

• Revenue Cycle
• Patient Access
• Claims Processing
• CMS Billing Guidelines
• Healthcare Compliance

• EHR System
• MEDITECH
• Clearinghouse
• SSI