Claims Escalation and Resolution Specialist I

Description

Quick Med Claims (QMC) is a nationally recognized leader in emergency medical transportation billing and reimbursement. QMC is committed to providing services in a manner that ensures compliance with all applicable billing and reimbursement regulations while maximizing the capture of allowable reimbursement for each client. The commitment to adherence to both principles make QMC the partner of choice for emergency medical transportation providers.

This position is 100% work from home.

The Claims Escalation and Resolution Specialist (CERS) plays an important and fundamental role in QMC’s RCM process by ensuring claims are coded and billed accurately and timely. The CERS must maintain a strong working knowledge of billing rules and regulations for all payor types in the various regions for which they process claims. The CERS must be detailed oriented and driven by the highest quality standards. The CERS is focused primary on resolving any issue that keeps a claim from being released to the appropriate payor.

Essential Duties & Responsibilities

• Reviews and manages the following claim statuses:
• Error
• Denied
• Rejected
• Identifies root causes and works to resolve claims in the above statuses.
• Collaborates with the Resolution Manager to provide updates, and updates SOPs as needed to prevent similar claim issues in the future.
• Attends and actively participates in daily resolution team huddles.
• Consistently meets daily performance and quality metrics for claim resolution.
  
  

Other Responsibilities

• Adhere to all QMC HIPAA privacy policies and procedures. This includes always maintaining the confidentiality and security of sensitive patient information.
• Ensures consistent adherence to company attendance policies.
  
  

Requirements

Education:

• High School Diploma required
  
  

Experience

• 3+ years EMS Billing preferred
  
  

Licenses, Certifications & Clearances

• Certified Ambulance Coder (CAC)
• QMC Biller Certified
  
  

Knowledge, Skills, Abilities

• Very detailed-oriented.
• Strong, working knowledge of EMS billing rules and regulations and understanding of health insurance payor groups (Medicare, Medicaid, Commercial).
• Ability to identify problems and escalate issues appropriately to a Resolution Manager.
• Ability to quickly adapt, learn and retain changing rules and specifications by clients, payors, states and MAC regions.
• Quality-focused and driven by process.
• Excellent problem-solving skills.
• RCM industry billing platform knowledge (preferred).