Job Directory Technical Resolution Specialist

Technical Resolution Specialist
Lewisville, TX

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Job Description

What We Are Looking For:

Under general supervision and in accordance with established policies and procedures, the Technical Resolution Specialist supports the claims revenue cycle process. 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 Revenue Cycle Management team to resolve issues ensuring that claims are adjudicated properly and timely.

What You Will Do:

* Set up, maintain, document and process group information within the RCM systems (NextGen and Admin)
* Handle inbound calls from members / internal service partners related to claims adjudication or other technical issues
* Perform root-cause analysis of issues; recommend and implement appropriate solutions in consultation with necessary stakeholders
* Provide reports and data analysis on a regular basis
* Research and respond to questions and requests in a timely, accurate and professional manner
* Work on assigned claims and complete necessary claim resolution activity as defined in departmental policies and procedures, including:
* Access claims from the work queue and query claim status with the payer, utilizing all appropriate systems to effectively research the claim
* Prioritize claims based on aging and outstanding dollar amounts, or as directed
* Complete follow-up with patients to obtain additional information, when necessary
* Complete and/or request adjustments as appropriate based on the dollar threshold of the adjustment
* Review, work and report claims that have aged more than the specified grace period stipulated in the policies and/or contracts
* Track and report violations 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 and/or any open requests for either insurance and/or member refunds
* Escalates claim resolution to management when necessary
* Interact directly with internal partners, payers, members and clients in a courteous, effective and professional manner
* Maintain 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, complying with all applicable regulations (Ex: HIPAA)
* Take initiative for learning new skills and willingness to participate and share expertise on projects, committees and other activities, as deemed appropriate
* Collaborate with and assist internal team members and departments as needed
* Perform other duties as assigned


* High school diploma required, bachelor's degree or equivalent industry experience preferred
* 1 - 2 years of administrative and systems experience in the healthcare industry required
* Strong computer skills required, familiarity with RCM software such as Krystal/NextGen/SQL is a plus
* Experience in insurance claim follow-up in a Physician practice environment preferred
* Strong analytical skills to generate reports to internal partners
* Ability to communicate and work with payers to get claims resolved and paid accurately
* Ability to effectively communicate verbally and in writing with payers, clients and team members
* Willingness to be flexible and team-oriented
* Highly organized and task-oriented

Compensation & Company Benefits (Here is some of the good stuff):

* Very competitive salary & equity compensation
* Excellent health, dental, vision coverage
* 401k benefits with 4% employer matching contribution
* Awesome people to work with
* Becoming a part of a movement in telemedicine and building something that matters

For a more detailed look at our company and values, visit our website at

At Teladoc Health we thrive on difference and individuality. Teladoc Health is proud to be an equal opportunity workplace and is an affirmative action employer. We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity or Veteran status.

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