Appeal Resolution Specialist jobs in San Antonio, TX

Job Title/Position: Orders Resolution Specialist

Reports to: Director of Authorizations/Intake/Eligibility

Position Summary:

The Orders Resolution Specialist will play a crucial role in managing and resolving billing issues that may arise due to orders in the billing process. The ORS's primary responsbility will be to investigate, identify, and rectify and discrepancies, errors, or obstacles that hinder the billing cycle, ensuring a smooth and efficient process from start to finish.

ESSENTIAL JOB FUNCTIONS/RESPONSIBILITIES

• Receive, review, and process orders from physicians for home health services. Provide guidance and training to operations staff on proper documentation practices.
• Ensure compliance with federal, state, and agency regulations and policies. Generate regular reporting detailing key billing metrics to Senior Management with analysis.
• Communicate with physicians, nurses, patients, and other staff to coordinate care and resolve issues.
• Maintain accurate and timely documentation of orders and patient records.
• Monitor and track the status of orders and follow up as needed.
• Act as point of contact for the billing resolution specialist to collectively work on billing holds related to orders.
• Collaborate closely with internal teams, including authorization, intake, and eligibility to ensure billing processes are being followed.
• Pro-actively identify opportunities to monitor billing workflows and prescribe improvements to processes.

POSITION QUALIFICATIONS

1. High school diploma or equivalent.

2. Experience in home health, medical billing, or health care administration preferred.

3. Knowledge of home health regulations, coding, and reimbursement.

4. Proficient in computer skills, including Microsoft Office and electronic health records.

5. Excellent customer service, communication, and organizational skills.

6. Ability to work independently and as part of a team.

SKILLS REQUIRED

1. Ability to examine documents for accuracy and completeness as well as to keep paperwork organized and accessible.

2. Skillful in computer systems, applications, and a calculator.

3. Team-oriented, diplomatic, and persuasive communication skills.

4. Skill in reconciling system documents to source documents.

5. Ability to improve processes to incorporate maximum efficiency.

6. Skillful in multitasking and task prioritization.

Job Type: Full-time

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Day shift

Education:

• High school or equivalent (Preferred)

Experience:

• Home health: 1 year (Required)
• Medical billing: 1 year (Required)
• Health care admistration: 1 year (Required)
• Microsoft office and electronic health records: 1 year (Required)
• Coding and reimbursement: 1 year (Required)

Ability to Relocate:

• New Braunfels, TX: Relocate before starting work (Required)

Work Location: In person