Claims Resolution Specialist I in Florida at Sunbelt Medical Billings LLC

Position Summary

The Claims Resolution Specialist I is an hourly, non-exempt individual contributor responsible for resolving routine patient and insurance accounts to support timely reimbursement and exceptional client service. This position performs account follow-up, researches claim status, communicates with insurance carriers and patients, resolves routine billing and payment issues, and maintains accurate account documentation. Working under the guidance of the Team Lead, the Claims Resolution Specialist I follows established procedures while escalating complex reimbursement issues when appropriate.

Essential Job Functions

• Perform timely follow-up on assigned patient and insurance accounts to facilitate prompt reimbursement.
• Research claim status and resolve routine billing, payment, denial, and eligibility issues in accordance with client and payer requirements.
• Communicate professionally with insurance carriers, patients, clients, and internal stakeholders regarding account resolution.
• Prepare and submit routine appeals in accordance with payer requirements, client guidelines, and company procedures.
• Review assigned accounts for billing accuracy and identify documentation, coding, or payment issues requiring correction.
• Communicate with patients regarding account balances, payment options, and account resolution while maintaining professionalism and confidentiality.
• Escalate complex reimbursement, contractual, or payer issues to the Team Lead or Complex Claims Specialist when appropriate.
• Maintain complete, accurate, and timely documentation within client and company systems.
• Meet established productivity, quality, and timeliness standards while maintaining accuracy.
• Maintain compliance with HIPAA, client requirements, payer guidelines, company policies, and applicable regulations.
• Perform other duties and special projects as assigned.

Education

• High School Diploma or GED required.
• Associate degree preferred.

Experience

• Minimum two (2) years of healthcare revenue cycle, medical billing, collections, or accounts receivable experience.
• Experience performing healthcare accounts receivable follow-up, insurance collections, or medical billing functions preferred.

Licenses/Certifications

• None required.

Preferred Qualifications

• Knowledge of healthcare reimbursement principles and insurance billing processes.
• Experience using Epic, Cerner, or comparable electronic medical record and billing systems.
• Strong client service and communication skills.
• Bilingual (Spanish or French) preferred.

Knowledge, Skills & Abilities

• Knowledge of healthcare reimbursement and insurance billing practices.
• Effective verbal and written communication skills.
• Strong organizational and time management skills.
• Attention to detail and accuracy.
• Critical thinking and problem-solving abilities.
• Ability to prioritize workload in a production-driven environment.
• Strong client service orientation.
• Proficiency with Microsoft Office applications and standard business software.
• Knowledge of HIPAA privacy and security requirements.
• Ability to work independently while collaborating effectively with team members.

Physical Demands & Work Environment

• Prolonged periods of sitting while working at a computer.
• Frequent use of a computer, keyboard, mouse, telephone, and other standard office equipment.
• Ability to communicate effectively verbally and in writing.
• Occasionally lift or move items weighing up to 15 pounds.
• Maintain a secure, distraction-free remote work environment.
• Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions of this position.