We are actively seeking a skilled and motivated Medical Billing & Claims Resolution Specialist to join our team. The ideal candidate will possess a strong understanding of medical billing, medical claims resolution, and the appeal process while also demonstrating a positive, solution-focused attitude. We are looking for someone who not only thrives in managing complex billing processes but also brings a hopeful outlook to challenges and enjoys celebrating achievements, both big and small. Please forward your resume with an email message introducing yourself to Lisa Griffin at Lisa@accessmorejoy.com

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Successful Applicants will have these Qualifications:

• Proven experience in medical billing and claims resolution with a minimum of 2 years

• In-depth knowledge of medical insurance, medical terminology, and the claims process.

• Experience with medical billing software and electronic claims submission platforms.

• Ability to analyze and resolve complex billing and claims issues.

• Knowledge of medical appeal processes and the ability to draft and submit appeals effectively.

• Detail-oriented with excellent organizational skills.

• Strong communication skills, both written and verbal.

• Ability to work independently and meet deadlines.

• Certification in Medical Billing and Coding (CPC, CBCS, or similar) is preferred.

• Strong interpersonal skills with an ability to build positive working relationships and collaborate with team members.

• A positive, optimistic outlook, especially when faced with challenges or difficult claims.

• A passion for celebrating team achievements, fostering morale, and contributing to a supportive work culture.

Responsibilities:

• Review and process medical claims in accordance with payer guidelines and policies.

• Resolve claims denials, underpayments, and discrepancies through thorough analysis and effective communication.

• Work with insurance companies and healthcare providers to correct claim issues and ensure accurate reimbursement.

• Submit and track appeals for denied claims, ensuring timely follow-up and resolution.

• Ensure compliance with CPT coding standards, payer requirements, and HIPAA regulations.

• Prepare and maintain accurate documentation of claims and appeals activities.

• Provide recommendations to improve the billing and claims resolution process.

• Collaborate with internal teams, such as coding and insurance departments, to resolve complex billing issues.

• Assist in identifying trends in claim rejections and denials to implement preventive measures.

• Foster and maintain positive, professional relationships with team members and stakeholders.

• Approach challenges with a hopeful and solution-oriented mindset, keeping morale high even when faced with setbacks.

• Celebrate team achievements and milestones, contributing to a positive and supportive work environment.

• Enjoy and take pride in investigative processes, demonstrating a natural curiosity and joy in problem-solving.