Claims Resolution Specialist

Details

• Department: Ascension Care Claims Management
• Schedule: Full-Time, 8-hour day shift, Monday-Friday, Fully Remote
• Facility: Automated Benefit Services (ABS)
• Location: Troy, Michigan

Benefits

Paid time off (PTO)
Various health insurance options & wellness plans
Retirement benefits including employer match plans
Long-term & short-term disability
Employee assistance programs (EAP)
Parental leave & adoption assistance
Tuition reimbursement
Ways to give back to your community

 

*Please note, benefits and benefits eligibility can vary by position, exclusions may apply for some roles (for example: PRN, Short-Term Option, etc.). Actual compensation offer will vary based upon role, education, experience, location, and qualifications. Connect with your Talent Advisor for additional specifics.

Responsibilities

As a Claims Resolution Specialist, you'll ensure client, provider, external and internal claims inquiries are researched and resolved.

• Review and respond to escalated internal and external emails from participants, providers and provider reps.
• Review provider fee schedules to resolve payment discrepancies on behalf of providers referred to this area by the provider relations team or the client.
• Work closely with the claims and adjustment team to have claims reprocessed.
• Research root cause issues and deliver resolutions to the client.
• Generate impact reports to analyze and troubleshoot errors with provider fee schedules and claims processing errors when referred by the claims department, customer service, leadership, provider relations team or the client.
• Evaluate medical claims for accuracy, completeness, and adherence to regulatory guidelines while minimizing financial discrepancies.
• Verify and ensure proper coding on medical claims, identifying discrepancies and rectifying errors.
• Investigate and resolve complex claims issues via email, provider appeals, resubmitted claims and escalated requests.
• Staying current with regulations and company policies and procedures to guarantee compliance in claims processing.
• Adhere to quality and production standards.
• Knowledge of FACETS.

Requirements

Education:

• High School diploma equivalency with 2 years of cumulative experience OR Associate's degree/Bachelor's degree OR 4 years of applicable cumulative job specific experience required.

Additional Preferences

Additional Preferences:

• 3 - 5 years of proven medical claims experience, preferred.
• In-depth knowledge of medical coding systems(ICD-10, CPT, HCPCS) and familiarity with insurance regulations.
• Strong analytical and problem-solving skills with a keen eye for detail.

Why Join Our Team

Ascension associates are key to our commitment of transforming healthcare and providing care to all, especially those most in need. Join us and help us drive impact through reimagining how we can deliver a people-centered healthcare experience and creating the solutions to do it. Explore career opportunities across our ministry locations and within our corporate headquarters.

 

Ascension is a leading non-profit, faith-based national health system made up of over 150,000 associates and 2,600 sites of care, including more than 140 hospitals and 40 senior living communities in 19 states.

 

Our Mission, Vision and Values encompass everything we do at Ascension. Every associate is empowered to give back, volunteer and make a positive impact in their community. Ascension careers are more than jobs; they are opportunities to enhance your life and the lives of the people around you.

Equal Employment Opportunity Employer

Ascension will provide equal employment opportunities (EEO) to all associates and applicants for employment regardless of race, color, religion, national origin, citizenship, gender, sexual orientation, gender identification or expression, age, disability, marital status, amnesty, genetic information, carrier status or any other legally protected status or status as a covered veteran in accordance with applicable federal, state and local laws.

 

For further information, view the  EEO Know Your Rights (English) poster or EEO Know Your Rights (Spanish) poster.

 

As a military friendly organization, Ascension promotes career flexibility and offers many benefits to help support the well-being of our military families, spouses, veterans and reservists. Our associates are empowered to apply their military experience and unique perspective to their civilian career with Ascension.

 

Pay Non-Discrimination Notice

 

Please note that Ascension will make an offer of employment only to individuals who have applied for a position using our official application. Be on alert for possible fraudulent offers of employment. Ascension will not solicit money or banking information from applicants.

 

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This employer participates in the Electronic Employment Verification Program. Please click the E-Verify link below for more information.
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