Claims Resolutions Specialist

PRIMARY RESPONSIBILITIES:  Appeal Submission and Resolution: Prepare and submit well-documented and persuasive appeals for denied claims, leveraging payer guidelines, contracts, fee schedules, and medical records to resolve issues and trigger payments.  Escalation Management: Address claims escalated by Claim Status Specialists, resolving complex denial scenarios such as coding disputes, medical necessity issues, or payer policy conflicts.  Underpayment Resolution: Investigate and address discrepancies between expected and actual payments, taking corrective action to resolve underpayments.  Final Determination: Evaluate claims to determine if they are resolved or require further action, such as additional appeals, escalation, or account closure based on client requirements.  Account Closure: Review and close accounts when collection efforts have been exhausted, ensuring proper documentation and compliance with client guidelines.  Account Review Feedback: Identify incorrectly reso...