Department:  Billing Position:  Claims Resolution Specialist Employee Category:  Non-Exempt Reporting Relationship:  Manager of Revenue Cycle Management   Character First qualities: Decisiveness- The ability to recognize key factors and finalize difficult decisions. Dependability- Fulfilling what I consented to do, even if it means unexpected sacrifice Initiative – Recognizing and doing what needs to be done before I am asked to do it. Thoroughness – Knowing what factors will diminish the effectiveness of my work or words, if neglected. Flexibility – Willingness to change plans or ideas without getting upset.   Summary of Duties and Responsibilities: The Bilingual Claims Resolution Specialist will be responsible for working directly with patients and third-party payers to effectively resolve all unpaid claims. The primary focus is to maximize revenue for the organization and consistently work to improve the overall health of the Accounts Receivable (AR). Primary Duties and Responsibilities:   Works collaboratively with the Senior Claims Resolution Specialist and the Manager of Revenue Cycle Management to determine the focus of collection efforts after running the weekly AR report. Contacts third-party payers about outstanding balances and provide requested documentation to achieve resolution. Contacts patients with outstanding balances to obtain payment or set up payment plan. Sends patient statements and collection letters on past due balances. Tracks and follow-up monthly on payment plans to ensure compliance. Performs write-offs, adjustments, and refunds as directed. Works closely with the Billing team to initiate and respond to billing inquiries, requests for additional information, and outstanding balance resolution. Answers patient calls and billing questions. Processes medical records requests for payers from attorneys. Assists front desk staff with patient inquiries. Assists front desk staff with obtaining correct patient addresses. Meets established daily, weekly, monthly, and annual deadlines. Manages and maintains relationships with all payors to improve patient revenue. Upholds Medicare, Medicaid, and HIPAA compliance guidelines in relation to billing, collections, and PHI information. Follows written and verbal instructions from the Manager of Revenue Cycle Management and Sr. Claims Resolution Specialist. Exhibits professionalism in communication with patients, clients, insurance companies and co-workers. Participates in special projects as assigned. Supports Variety Care’s accreditation as a Patient Centered Medical Home and our commitment to provide care to all Variety patients that is Safe, Effective, Patient Centered, Timely, Efficient, and Equitable.  Provides leadership and work with all staff to achieve the goals of the “Triple Aim” of healthcare reform—to improve the experience of care, improve health outcomes, and decrease healthcare costs. Embodies the strength of personal character.  Places value on being an open and honest communicator who displays high moral and ethical conduct, integrity, adaptability, and sound judgment.  Must be a leader in the department and community. Result-oriented problem solver who is responsible and accountable. Performs other duties as assigned.   Requirements, Special Skills or Knowledge:   High School Diploma or GED. Two years prior billing and collections experience. Working knowledge of CPT codes. Ability to read and understand Explanation of Benefits (EOB) issued by insurance carriers. Expert critical independent thinking, analytics, problem-solving and sound decision-making skills. Experience interacting and communicating effectively with individuals at various levels both inside and outside the organization, often in sensitive situations. Proficient with Microsoft Office and practice management software systems. Preferred Requirements, Special Skills or Knowledge: Bilingual (English/Spanish). Associate degree or equivalent combination of experience and education. Prior medical billing and insurance collections or healthcare revenue cycle experience including diversified experience with payers, managed care contracts, and payer methodology. Essential Functions:   Must be able to lift and/or move up to 25 pounds. While performing the duties of this job, the employee is frequently required to sit, stand, walk and talk. Frequently required to bend and reach to fulfill job duties.