Resolution Analyst, Denials - Remote

Overview

The Resolution Analyst acts as a liaison between key client contacts and the denials and underpayment appeal process, facilitating payment recovery efforts for denied and underpaid accounts.

In Short

• Review and appeal outstanding claims.
• Identify correct reimbursements using payment documentation.
• Review hospital contracts for cash payments.
• Research and acquire medical records for appeals.
• Conduct follow-up with payers on claims.
• Ensure smooth operations and improve customer satisfaction.
• Handle patient health information with privacy.
• Other duties as required.

Requirements

• High School Diploma or GED required; Associates or Bachelor’s Degree preferred.
• 5+ years in healthcare billing or collections.
• 1+ years of customer service experience.
• Intermediate understanding of insurance claims processing.
• Strong computer proficiency, especially in MS Office.
• Intermediate knowledge of ICD, HCPCS/CPT coding.
• Understanding of the revenue cycle process.
• Knowledge of hospital reimbursement and Managed Care contracts.
• Familiarity with HMO, PPO, and capitation terms.
• Ability to review client/payer contracts for underpayments.

Benefits

• Stable work environment.
• Opportunities for professional growth.
• Supportive team culture.
• Recognition for productivity and performance.