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Claims Resolution Specialist
Innovaccer. Process medical claims according to Caduceus standards, client requirements, and industry guidelines .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in medical billing and claims resolution, with proficiency in the Athena billing platform and a solid understanding of CPT, ICD-10, and medical terminology. Capable of managing accounts receivable processes while ensuring compliance with HIPAA and industry standards.
Highest-signal resume keywords
3+ Years Experience In Claims ResolutionAthena Billing Platform ProficiencyKnowledge Of CPT And ICD-10Medical Billing Certification PreferredExperience With EMR Systems
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Medical BillingClaims ResolutionAccounts Receivable ManagementCPT CodingICD-10 CodingRevenue Cycle ManagementAppeals ProcessingEOB InterpretationData Entry AccuracyProductivity Metrics
Soft Skills
Excellent Communication SkillsProblem-Solving Under PressureOrganizational SkillsJudgment And InitiativeIndependent Work Capability
Tools & Technologies
Athena Billing PlatformMicrosoft Office SuiteEMR SystemsWeb Portals For InsuranceBilling And Collection Systems
Certifications & Qualifications
Medical Billing Certification Preferred
Industry Keywords
HIPAA ComplianceProtected Health InformationRevenue Cycle PoliciesFollow-Up ProcessesDenial Management
About the role
Key responsibilities & impact- Process medical claims according to Caduceus standards, client requirements, and industry guidelines
- Conduct accounts-receivable follow-up on front-end scrubs and back-end denials
- Scrub charges for submission and launch appeals through the Athena billing platform
- Review and clear registration, insurance, charge, and related claim edits for high-volume practices
- Read and interpret EOBs and denials from all insurance carriers, including co-pays, deductibles, and co-insurance
- Process appeals end to end across all payer categories
- Differentiate between appeal, coding review, credentialing review, and adjustment best practices
- Contact insurance companies and use web portals for appeal, eligibility, remittance, and payment information
- Report and communicate issues and trends
- Meet or exceed productivity expectations of at least 6 denials per hour, approximately 45 per day, while maintaining accuracy and quality
- Demonstrate mastery of essential functions in a testing environment
- Perform other duties as assigned
Requirements
What you’ll need- 3+ years of experience in claims resolution or medical billing
- Minimum of 2 years of documented experience on the Athena billing platform highly preferred
- Additional EMR experience including Cerner, NextGen, and EPIC is a plus
- Ability to pass skills test on the platform
- Formal certification in medical billing preferred but not required
- Working knowledge of CPT, ICD-10, and medical terminology
- Complete understanding of follow-up processes
- Solid background in accounts receivable and revenue cycle policies and procedures
- Experience in a medical billing environment with protected health information and HIPAA compliance
- Excellent communication skills
- Experience with EMR, billing, and collection systems
- Proficiency in Microsoft Office Suite, including Word and Excel
- Bachelor's degree or medical billing certificate preferred
- Ability to communicate clearly orally and in writing
- Ability to communicate effectively with senior leadership and company personnel
- Ability to plan, manage, and lead projects
- Ability to make decisions and solve problems under pressure
- Ability to prioritize and organize effectively
- Ability to demonstrate judgment and initiative
- Ability to work independently
- Strong business acumen
- Effective communication skills, including public speaking
- Ability to lift and move approximately 30 pounds on a non-routine basis
- Ability to sit for extended periods and use a computer for long periods
- Ability to handle, seize, hold, grasp, and finger objects, tools, and controls
- Close vision
- Ability to receive detailed information through oral and telephonic communication
- Employment eligibility verification required for employees based in the United States
Benefits
Comp & perks- 20 days of fixed paid time off per year, in addition to company holidays
- Generous parental leave
- Monetary incentives and company-wide recognition
- Medical, dental, and vision insurance
- 100% company-paid short- and long-term disability insurance
- 100% company-paid basic life insurance
- Discounted legal aid
- Pet insurance
- Remote work environment