Claims Resolution Specialist

Job ID


Working under the supervision of the Director of Revenue Cycle Management, the Claims Resolution Specialist is responsible for various tasks associated with all billing, reimbursement, and related functions supporting the successful management of all ConvenientMD claims and accounts receivable. The Claims Resolution Specialist provides constant and proactive communication to enhance both clinic performance and foster a positive relationship within the ConvenientMD organization.


  • Maintains confidentiality in all aspects of patient, staff and company information.
  • Proactively provides payor specific and/or specialty specific feedback and information related to any compliance issues and/or billing related issues.
  • Interacts with clinic staff, software and related vendors, and insurance companies.
    • Phone interaction with all above
    • Written communication with all above
    • Web interaction
  • Prepare responses to correspondence regarding patient and third party payor inquiries.
  • Demonstrates flexibility and teamwork, understands the interaction between the role of the billing Analyst and others with whom the position works directly and indirectly. 
  • Completes all responsibilities according to established protocols, policies and standard practices in the areas of customer service, quality assurance and regulatory compliance programs such as HIPAA (Health Information Portability & Accountability Act), OSHA (Occupational Safety & Health Act) and CLIA (Clinical Laboratory Improvement Administration).
  • Responsible for correct coding and billing of services based on guidelines set forth by the contracted health insurance companies.
  • Responsible for the mailing of patient statements and collection activities.
  • Work closely with the Director of Revenue Cycle Management/Clinic Managers regarding outstanding accounts.
  • Responsible for the follow-up and resolution of all claims outstanding.
  • All other duties as assigned.




Degree: Associates Degree required, Bachelor’s Degree preferred.

Coding Certification preferred, required within 6 months of hire.




Prior billing and accounts receivable related experience required.  Required to be detailed oriented and organized.  Prior experience with medical service business, and customer relations a must.  Working knowledge of the following software; DocuTAP or other practice management software, Word, and Excel.  Prior experience with web-based related products for document management, exchange of information and communication.



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