Claims Resolution Specialist

Western Missouri Medical Center

. Review errored and rejected claims in SSI and ensure patient demographics, insurance, coding, modifiers, units, and authorizations are complete .

Posted 10/16/2026full-timeUnited StatesJuniorMid-LevelWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

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.

Highest-signal resume keywords

Healthcare Billing ExperienceClaim Submission WorkflowsCPT, HCPCS, ICD-10 CodingEHR System ExperienceAttention to Detail

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Healthcare BillingClaim ValidationInsurance Billing ProcessesClaim SubmissionPayer EnrollmentCMS Billing GuidelinesError ResolutionDocumentation StandardsWorkflow AdherenceProductivity Targets

Soft Skills

Attention to DetailTime ManagementOrganizational SkillsEffective CommunicationTeamwork

Tools & Technologies

EHR SystemMEDITECHClearinghouseSSI

Industry Keywords

Revenue CyclePatient AccessClaims ManagementHealthcare ComplianceMissouriKansas

About the role

Key responsibilities & impact

Review errored and rejected claims in SSI and ensure patient demographics, insurance, coding, modifiers, units, and authorizations are complete
Submit healthcare 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 escalate 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 established SLA, typically less than 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, clean claim rate contribution, workflow adherence, and documentation standards
Maintain regular and predictable attendance
Perform other essential duties as assigned

Requirements

What you’ll need

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
Must be able to sit and stand intermittently 8 to 10 hours a day
Must be able to use standard office equipment, including the telephone and computer keyboard
Ability to work under pressure while meeting near-100% accuracy and inflexible deadlines
Ability to lift or carry up to 40 lbs.