Acelity Careers

Resolution Specialist

Dillon, United States of America
Customer Administration


Job Description

SUMMARY

Position responsible for processing, evaluating and billing Medicaid, Commercial insurance claims as well as patient pay claims.  Claims denied reimbursement by the insurance company will be evaluated and processed in a timely manner, in accordance with State and Federal laws. 

 

DUTIES/RESPONSIBILITIES

  • Regular, punctual attendance.
  • Have working knowledge of the following computer programs:
    • Microsoft Word-fundamental
    • Microsoft Excel-fundamental
    • Microsoft Outlook-fundamental
  • Read and reply to email in a timely manner as needed.
  • Listen and respond to voicemail in a timely manner as needed.
  • To communicate effectively with patient as required.
  • Answer all incoming inquires regarding patient cases as appropriate.
  • Understand their role and impact they have in the departmental team; including exhibiting positive attitudes, willingness to help wherever asked, staying focused and on task to the matter at hand, and being part of the success of your team.
  • To learn and understand the billing requirements of insurance companies.
  • Daily production consistently meets stated goals for job position.
  • Process and bill claims to all insurance companies as well as the patient.
  • To investigate and analyze insurance claims denied reimbursement by reading documents, interfacing with insurance company personnel, patients, and the patient’s physicians and/or nurses, and negotiating computer based research.
  • To develop, for insurance claim denials, a reasonable patient product use detail and history; to develop and substantiate the product use evidence, and present the patients case as an appeal insurance companies.
  • To perform insurance transfers, post and document insurance claim status within the billing system, and generate insurance company denied claim status-follow up in the computer system.
  • To determine the necessity of a patient to be directly responsible for a portion of the claim charges not coverage by a primary or secondary insurance carrier.
  • Set up patient payment arrangements.
  • Validate qualification for hardship program.
  • Resolve customer concerns.
  • Determine and obtain prior authorization for new VAC placements as well as seek extended coverage.        
  • Perform other tasks as requested by Supervisor or Management Staff.

MINIMUM REQUIREMENTS/ABILITIES

  • High School Diploma or equivalent
  • Effective Communication Skills
  • PC Skills
  • Working 10-key and/or keyboarding skills
  • Proficiency in general office duties
  • Ability to prioritize
  • Attention to detail
  • Ability to enter data accurately
  • Demonstrate good interpersonal skills
  • Ability to maintain complete confidentiality and discretion in business relationships
  • Demonstrate willingness and ability to participate in, and complete, all required training programs
  • Ability to work effectively and exercise sound business judgment in a team environment, as well as independently
  • Demonstrate flexibility in work shift to meet department needs
  • Demonstrate ability to deal effectively with all employees and external business contacts while conveying a positive service-oriented attitude
  • Perform duties in an accurate and complete manner evaluated and validated via quality assurance assessment

PREFERRED QUALIFICATIONS

  • General office experience required.

Minimum requirements:     

  • PC skills to include Excel and Word
  • Ability to work in a team environment as well as independently
  • Excellent telephone skills
The information listed above is not a comprehensive list of all duties/responsibilities performed. This job description is not an employment agreement or contract. Management has the exclusive right to alter this job description at any time without notice. Any physical and mental requirements described in this job description are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. EOE AA M/F/Vet/Disability: Acelity L.P. Inc. and its subsidiaries are an equal opportunity and affirmative action employer and give consideration for employment to qualified applicants without regard to race, ethnicity, color, religion, sex, sexual orientation, gender identity, pregnancy, national origin, age, disability, veteran status, or genetic information or any other legally protected characteristic. If you'd like more information about your EEO rights as an applicant under the law, please click here: http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf VEVRAA Federal Contractor