Under general supervision and in accordance with established policies and procedures, the Accounts Resolution Representative will support the claims revenue cycle process. Primarily communicates with internal departments to resolve issues surrounding outstanding claim payments.
This role works closely with internal service partners within Teladoc to determine the root cause of claims issues and works directly with other members of the Denials Management & Collections team to resolve issues ensuring that claims are adjudicated properly and timely.
- Represents Teladoc Health to payers, members, and clients in a courteous and professional manner
- Analyzing denials and outstanding claims to determine appropriate remediation actions to resolve root causes and reduce/eliminate denials
- Handle inbound calls from members / internal service partners that are related to claims adjudication issues.
- Researches and/or ensures that questions and requests for information are addressed in a timely and professional manner to ensure resolution of outstanding claims
- Prioritizes claims based on aging and outstanding dollar amounts, or as directed by management
- Accesses claims from the work queue and queries claim status with the payer, utilizing all appropriate systems to effectively research the claim
- Works on assigned claims and completes all necessary activity as defined in departmental policies and procedures
- Completes follow-up with patients to obtain additional information, when necessary
- Completes and/or requests adjustments to a claim, as appropriate, based on the dollar threshold of the adjustment
- Reviews, works and reports all claims that have aged more than the specified grace period stipulated in the policies and/or contracts
- Tracks and reports violation of prompt pay or adjudication terms by payers
- Resolve through inbound or outbound media any open patient/member balances
- Research and resolve any open credit balances
- Research and resolve any open requests for either insurance and/or member refunds
- Escalates claim resolution to management when necessary
- Maintains the privacy and security of all confidential and protected health information. Uses and discloses only that information which is necessary to perform the function of the job
- Takes initiative for learning new skills and willingness to participate and share expertise on projects, committees and other activities, as deemed appropriate
- Provides assistance to other departments
- Complies with all applicable regulations (Ex: HIPAA)
- Performs other duties as assigned
- Team player
- Ability to work in a fast pace environment and learn quickly
- Excellent customer service skills
- Task Oriented
- Time Management
- Able to navigate in a windows environment
- Skilled in organizing and prioritizing work
- Ability to create and communicate procedures and adapt to changes in working environment
- Able to multi task
- Focused with a sense of urgency
- Accurate and attentive to detail
- High school diploma required, Bachelor’s degree or equivalent industry experience is preferred
- 1 -2 years business office experience in a healthcare environment
- Experience in insurance claim follow-up in a Physician practice environment preferred
- Excellent phone etiquette and internal/external customer service skills required
- Ability to communicate and work with payers to get claims resolved and paid accurately
Why Join Teladoc Health?
A New Category in Healthcare: Teladoc Health is transforming the healthcare experience and empowering people everywhere to live healthier lives.
Our Work Truly Matters: Recognized as the world leader in whole-person virtual care, Teladoc Health uses proprietary health signals and personalized interactions to drive better health outcomes across the full continuum of care, at every stage in a person’s health journey.
Make an Impact: In more than 175 countries and ranked Best in KLAS for Virtual Care Platforms in 2020, Teladoc Health leverages more than a decade of expertise and data-driven insights to meet the growing virtual care needs of consumers and healthcare professionals.
Focus on PEOPLE: Teladoc Health has been recognized as a top employer by numerous media and professional organizations. Talented, passionate individuals make the difference, in this fast-moving, collaborative, and inspiring environment.
Diversity and Inclusion: At Teladoc Health we believe that personal and professional diversity is the key to innovation. We hire based solely on your strengths and qualifications, and the way in which those strengths can directly contribute to your success in your new position.
Growth and Innovation: We’ve already made healthcare yet remain on the threshold of very big things. Come grow with us and support our mission to make a tangible difference in the lives of our Members.
As an Equal Opportunity Employer, we never have and never will discriminate against any job candidate or employee due to age, race, religion, color, ethnicity, national origin, gender, gender identity/expression, sexual orientation, membership in an employee organization, medical condition, family history, genetic information, veteran status, marital status, parental status or pregnancy (including breastfeeding – we have a mother’s room in both our offices). In our innovative and inclusive workplace, we prohibit discrimination and harassment of any kind.