Business Resolution Specialist Jobs

Strong Knowledge of healthcare claims, Medicaid, Medicare, Pharmacy benefits, etc.

Schedule: Full-Time, 8am - 5pm, Mon-Fri, fully remote

Facility: Automated Benefit Services (ABS)

Complex Medical Claims experience, preferred

5 years of healthcare experience, preferred

Review and respond to escalated internal and external calls and emails from participants, providers and provider reps.

This job may operate remotely.

Prior call center experience preferred.

Strong organizational and interpersonal skills.

Strong analytical and problem-solving skills.

Excellent phone skills with the ability to listen to others.

This job may operate remotely and/or in the office, based on the needs of the business.

Performs other related duties as assigned by management

Ability to work with all levels of management.

Strong organizational, problem-solving, and analytical skills; able to manage priorities and workflow.

Dependability – Follows instructions, responds to management direction, completes tasks on time or notifies appropriate person of alternative plan.

Knowledge of Complex Rehabilitative Equipment including but not limited to coding, modifiers, narrative information, parts, repairs, and loaner equipment.

Ability to analyze and/or gain knowledge to interpret Commercial, Medicaid, Medicare, and Medicare Advantage Plan Local Coverage Determinations and Policy Guidelines.

Manage internal collection queue with varying stages of delinquency and past due balances.

Minimum of three (3) years collections experience in consumer or commercial collections.

General knowledge of collections regulations.

100% Remote. Flexible Work Schedule & Location.

Work From Home / Internet / Cell Phone Stipend.

Initiate contact with delinquent borrowers on a consistent basis via outbound call and email communications.

Actively participate in team huddles and meetings by way of sharing knowledge, requesting information, and recommending process improvements

Maintain the knowledge of payer policies; complete AAHAM or other healthcare related webinars

We offer 4 weeks of training. The hours during training will be 8:00am - 4:30pm EST.

Take necessary AR adjustments in accordance with the department’s adjustment policy

Meet or exceed the Northern Light Health performance standards as it relates to quality and productivity

Request relevant information from appropriate revenue cycle and clinical departments as required by payer

Clear and concise verbal and written communication skills; ability to communicate with customers, associates and management in a professional manner

Create related reports for clients, finance managers and other key stakeholders

Manage weekly settlements within the defined timeframe, when requested

Manage and monitor improvement actions to measure the success of changes and enhancements

1 year of experience in a customer service-oriented environment

Some experience in accounting, invoicing or freight audit and payment operations

Training or knowledge of education law, particularly special education, and preferably student discipline, bullying and other mandated areas

Providing technical assistance and guidance to parents, advocates and school administrators on the implementation of regulatory requirements.

Strong interpersonal, communication skills – ability to communicate and work effectively with a wide range of constituencies in a diverse community.

An Equal Opportunity/Affirmative Action Employer. Females, minorities, veterans, and persons with disabilities are strongly encouraged to apply.

Performing other duties as required.

The successful candidate will possess:

At least 2 years of experience with the dispute management process for a fintech company, startup, or bank

Strong Microsoft Office or Google Workplace skills; ideally experience using Slack

Manage the end-to-end process of investigating card fraud and transaction disputes

Manage reporting to our banking partner and internal stakeholders

Interest in or experience with process improvement for back-office operations (ideally in a financial services environment)

Excellent written and verbal communication skills for interfacing with customers, vendors, and internal teams

Offer guidance, support, and education to employees to help prevent future resolution issues.

Deliver an outstanding positive customer experience to consumers and frontline advisors

Provide support to customer experience team by handling supervisor and requested resolution chats through our Internal bot platform.

Optimize customer experience on every interaction (Internal/External) by demonstrating a willingness to assist

Thoroughly walk Customer Experience team through proper troubleshooting steps utilizing appropriate resources (Resolve/TechSee)

Strong written, verbal, and interpersonal skills- Sustain a high level of call quality at all times

Identify appropriate escalation points and work with direct manager to resolve issues

Prior experience in a role requiring communication with government caseworkers and hospital personnel

All Telecommuters will be required to adhere to Hiring Company’s Telecommuter Policy.

Monitor and foster ongoing communications with government agencies regarding the status of claims

Review inbox for daily work queues, identifies missing evidence and follows through to completion

Answer incoming calls from internal and external customers

Education assistance (tuition, student loan, certification support, dependent scholarships)

Identify potential claim issues and escalate to management

Family support through fertility and family building benefits with Progyny and adoption assistance.

Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income.

Maintain working knowledge of workflow, systems, and tools used in the department

Learn More About Employee Benefits

Education assistance (tuition, student loan, certification support, dependent scholarships)

Identify potential claim issues and escalate to management

Family support through fertility and family building benefits with Progyny and adoption assistance.

Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income.

Maintain working knowledge of workflow, systems, and tools used in the department

Learn More About Employee Benefits

1+ year of full time experience in a call center customer service environment preferred; remote work experience preferred

Technical Requirements (for remote workers):

Must provide accessibility to secure, quiet work space with direct high-speed internet connection to effectively work remotely

Answer high volume, inbound phone calls from patients, utilizing a cloud based phone system.

Educate our patients on patient financial responsibility surrounding deductibles, copays, and coinsurance.

Confidently inform and collect patient balances using Privia financial policy guidelines.

Prepares for and attends trials, hearings and conferences and reports to Home Office and local management on status.

May be involved in special projects and/or mentoring at the direction of local management.

May assist in the absence of the Claims Team Manager, representing the company on matters involving state or federal regulatory agencies.

Must have an expert knowledge of coverage, liability, and complex claims handling procedures.

Must be knowledgeable of state and federal laws in the adjuster's jurisdiction.

A full working knowledge of claims operations and procedures is required.

Monitor response time and inquiries from internal and external stakeholders in the askUS issues management system.

Knowledge of and experience in interpreting and applying policies and procedures.

Experience applying skills to research, interpret, analyze, compile, and present data and information.

Experience in decision making, problem-solving and analytical skills to solve moderately complex issues requiring sound judgment, discretion and tact.

Manage department website, develop and distribute department newsletter, and manage department forms.

Ability to deal with and manage heavy workloads during peak periods.