Option Care Claims Resolution Specialist in Cleveland, Ohio

Option Care is a healthcare services company that at its core delivers high quality, cost effective infusion services through trusted partnerships across the healthcare system, resulting in outcomes that make a positive difference in people’s lives.

Job Description Summary:

The Claims Resolution Specialist is responsible for providing a high level of customer service to network providers, answering their questions and providing requested information on claim status and appeals.

Job Description:

Job Responsibilities:

  • Maintains agency claim status via the spreadsheet and phone communication. Manages provider appeals and claims resolution. Works with billing and collections to complete any of the above.

  • Prepares reports of an agency’s outstanding accounts. Generates status reports for the agency at their request or at the request of the Company.

  • Works with the Director on department process and documentation requirements, as they relate to the Company’s network providers.

  • Provides support to providers with billing procedures questions.

  • Routes provider retro submissions to billing for processing.

  • Works with the Network department to identify agencies who need support and training.

  • Compares invoices to what has been entered. Audit for accuracy.

  • Codes and enters provider invoices into MAS 90 accounting software, approves invoices for payment after confirming reimbursement from payers.

  • Assists with all payer audits, providing documentation as needed.

  • Completes month end / AP closing in conjunction with Company deadlines.

  • Other duties as assigned by management.

Supervisory Responsibilities: i.e. hiring, recommending/approving promotions and pay increases, scheduling, performance reviews, discipline, etc.


Basic Education and/or Experience Requirements:

Minimum of high school diploma or equivalent.

Previous reimbursement or claims processing experience

Basic Qualifications & Interests:

  • Proven success in customer service.

  • Effective communications skills for interacting with clients, payers, and co-workers

  • Excellent organizational and time management skills

  • Excellent problem-solving and team building skills

  • Intermediate computer skills, including knowledge of Microsoft Office programs

Preferred Qualifications & Interests:

At least 1 year of previous experience in reimbursement or claims processing

Additional education (certificate program or college curriculum) preferred

This job description is to be used as a guide for accomplishing Company and department objectives, and only covers the primary functions and responsibilities of the position. It is in no way to be construed as an all-encompassing list of duties.

Option Care subscribes to a policy of equal employment opportunity, making employment available without regard to race, color, religion, national origin, citizenship status according to the Immigration Reform and Control Act of 1986, sex, sexual orientation, gender identity, age, disability, veteran status, or genetic information.

Option Care is a leading provider of home and alternate treatment site infusion services. With a staff of more than 1,700 clinical experts – including specially trained infusion nurses, infusion pharmacists and registered dietitians – Option Care treats patients with a wide range of acute and chronic conditions. Comprehensive therapy management programs are offered for patients with nutrition disorders, bleeding disorders and heart failure, as well as those needing immunoglobulin (IG) therapy and anti-infective therapy. Option Care is able to provide services to 92% of the nation’s population through more than 90 infusion pharmacies and 100 alternate treatment sites across the country.