|Employer:||Monida Healthcare Network
|Required Experience:||1 to 2 years
|Preferred Experience:||3 to 4 years
POSITION SUMMARY: The Claims Resolution Specialist is responsible for applying
fundamental knowledge of the healthcare revenue cycle practices and procedures
as it relates to researching, analyzing, and resolving claims. This job
requires regular outreach and assistance to the Monida members and payers. Must
be accountable for maintaining accurate records of correspondence with
providers and payers. This position is responsible for examining and
researching denied and potentially underpaid claims, when necessary. The
position serves as an escalation resource to the Monida members and payers and
acts as the liaison. Must demonstrate strong independent judgment in evaluating
the claims processing and reporting the status back to the provider and/or payer
in a timely fashion. This position also works with the payers on demographic
updates, new provider additions/deletions, etc. Coding knowledge, and
payer fee schedule experience is desired. This is a non-exempt position.
CONDITIONS: 20-32 hours per week. Schedule is negotiable
but hours will be worked during normal business hours of 8am-5pm Monday through
Friday at the Monida offices located in Missoula MT.
- Establishes working relationships with Monida members and payer
contacts as a main priority.
- Receives claim and/or billing issues from Monida members and
analyzes the issue per contract terms.
- Directs correction request of claim and/or billing issues to
- Communicates actions taken to member and/or staff and keeps
documentation in file for follow-up with member office.
- Follows-up with member and/or staff to assure results received and
- Maintains familiarity with contracted payer reimbursement.
- Meets with members or payer contacts as needed.
- Provides fees analysis and reporting of analysis at the request of
- Provides RBRVS unit values per CPT codes at the request of members
and maintains master spreadsheet.
- Maintains website look-up tool and master spreadsheet for annual
- Sends new, updates or term panel form to payers along with monthly
roster spreadsheet by payer.
- Works with the AMA on annual pricing for coding book program and
answers any questions for members regarding program. Works with the Monida Controller on
- Maintains updated Fees Authorization Forms from members and
ensures current in software to be able to run queries for contracts.
- Performs proactive reviews of contract reimbursement through
provider offices and provides reporting back to the provider office once
- Informs and educates members involving contracted payer issues via
email blasts, newsletters, etc.
- Receives input from members regarding reimbursement problems that
affect the membership as a whole and works with the involved payer to
resolve these problems. Involves other Monida personnel as necessary.
- Identifies and responds to problematic changes in payer
reimbursement policies and/or procedures.
EDUCATION: Bachelors degree preferred.
CERTIFICATE/LICENSE: None required, but CPC or CCS strongly
EXPERIENCE: Three years experience in medical billing or coding.