Claim Reconciliation Specialist

Solaris Health - Westchester, IL

Full-time - Mid Level

Westchester, IL

About the position

The Claim Reconciliation Specialist is responsible for overseeing the claim reconciliation process within the Mid-Revenue Cycle, focusing on identifying issues and opportunities for process improvement. This role plays a critical part in revenue leakage analysis and resolution, supporting revenue cycle workflows, charge capture, and work queue processes. The specialist will evaluate, validate, and trend data to optimize the Revenue Cycle and report findings to various levels of the organization.

Responsibilities

• Monitor scheduling and revenue reports for all practice locations to ensure timely and appropriate charge entry according to reconciliation policy standards.
• Ensure practice adherence to charge reconciliation processes.
• Work on Missing Encounter Reports to identify and post missing charges accurately and timely.
• Run weekly and monthly surgery schedules to ensure all scheduled surgeries and related charges are billed.
• Monitor late charges and write-offs by reviewing reports weekly to determine root causes for late charges.
• Maintain charge screens and department charge master files.
• Provide feedback to the Coding and Revenue Integrity Manager regarding providers/clinicians/practices not meeting charge entry standards.
• Perform quantitative and financial analysis from daily audit findings related to charge capture.
• Provide estimated revenue impact from audit findings to leadership.
• Collaborate with the Revenue Integrity Team, Clinical Operations, and RCM staff to implement corrective actions for compliant charges and prevent future rejections/denials.
• Respond to queries regarding charges.
• Participate in ongoing coordination and resolution of revenue issues as they arise.
• Assist in troubleshooting and resolving issues related to the patient mid-revenue cycle.

Requirements

• High School Diploma or equivalent required.
• Minimum of three years' revenue cycle experience within a physician practice.
• Knowledge of medical terminology, CPT, ICD coding, and the entire revenue cycle process.
• Experience in Urology or physician practice environment preferred.
• Demonstrated understanding of business and how actions contribute to company performance.
• Excellent customer service skills.
• Knowledge of EHR software systems and Microsoft Office products.
• Excellent verbal and written communication skills.
• Strong analytical skills with the ability to make conclusions and recommendations.
• Ability to handle multiple tasks with excellent problem-solving skills.
• Well organized with the ability to maintain accuracy and confidentiality.
• Ability to work collaboratively across disciplines and business lines.
• Ability to develop reports and create presentations.
• Ability to work independently and manage deadlines.

Nice-to-haves

• Coding and/or Physician Billing Certification, preferred.