Claims Resolution Specialist - Carrier Relations

JOIN OUR GROWING CLAIMS DEPARTMENT AT MEDLYTIX! The Claims Resolution Specialist plays a key role in resolving open receivables for our clients. You will process medical (physician and hospital) bills that involve motor vehicle accidents, workers' comp, and third-party claims. The Claims Resolution Specialist will work toward increased reimbursement and account resolution. Responsibilities: Works independently to identify issues with claim submissions; identifies corrective steps; follows issue through to resolution. Provide exceptional customer service for inbound calls. Interface with insurance agents, patients, and others to the disposition of each account. Identify obstacles to claim submission and payment, including updating insurances, adjuster contact information, submitting bills, and providing requested documentation. Identify patterns with payers that result in non-payment or delayed payment. Ability to summarize and escalate in the correct manner. Update accounts in our proprietary technology platform to increase probability of collection and resolution of accounts. Rely on experience and judgment as well as instructions and pre-established guidelines to plan and accomplish goals and perform a wide variety of tasks. Required Skills: Experience in healthcare revenue cycle, particularly physician billing, claims resolution, and customer service. Understanding and concern for patient privacy and HIPAA compliance Ability to interpret payer EOBs and understanding of coordination-of-benefits concepts. Excellent customer service, verbal and written communication skills Ability to review and interpret account information to successfully resolve account issues. Attention to detail in identifying, comparing & transferring data (particularly numbers) Ability to effectively navigate multiple systems to download & transfer files. Ability to research & follow written guidelines to determine next steps when conflicting information is presented Ability to identify trends/issues and communicate these to supervisors. Basic-to-Intermediate Microsoft Excel Skills Excellent Data Entry Skills Education and Experience: Bachelor's degree preferred, High School diploma or GED required Health Information Management credential (RHIA, RHIT, CAHIMS, CPHIMS) preferred 2+ Years of Healthcare Revenue Cycle Experience Inbound Call Center Experience Preferred bilingual - fluent in speaking Spanish Preferred prior experience as team-lead, supervisor, or manager Location: Roswell, Georgia (hybrid role) OR Ohio (fully remote) Why Medlytix ? Competitive Pay Competitive Paid Time Off Comprehensive Medical, Dental, Vision and 401K Packages Family Support Benefits Paid Company Holidays As part of our commitment to quality and excellence, Medlytix will continue to maintain a safe and healthy environment for you by requiring all applicants to submit to a criminal history check and those tentatively selected for a position to submit to screening for illegal drug use prior to appointment for a job. In addition, applicants may be screened for ability to perform essential functions of some positions.