Claims Resolution Specialist

Claims Resolution Specialist

TSI Healthcare – Chapel Hill, NC

Since 1997, TSI Healthcare has helped empower physicians of all specialties to improve care, increase efficiency and maximize profitability. As a Value Added Support Organization for NextGen Healthcare, our services include Electronic Health Records (EHRs), Practice Management Systems, Online Patient Portal, Revenue Cycle Management services, among many others. TSI Healthcare operates a state-of-the-art headquarters in Chapel Hill, North Carolina. We take pride in delivering “concierge-style” support and service.

By The Numbers:

  • Over 200 team members
  • Over 2,200 physician clients in 38 states
  • Modern Healthcare’s “Best Places To Work” (2012, 2013, 2014, 2015, 2016,  2017 & 2018)
  • Inc. Magazine’s “Inc. 500 | 5000 Fastest Growing Private Companies” (2009, 2010, 2011, 2012, 2013, & 2017)
  • Triangle Business Journal’s “TBJ Fast 50” Fastest Growing Companies in the Triangle (2012 & 2013)
  • Stevie® Award – Top Ranked Service (2015, 2016,  2017 & 2018)

General Position Description:

We are currently recruiting Claims Resolution Specialists for our Revenue Cycle Management (RCM) Division to meet our corporate growth in the RCM Division. The complete TSI RCM team is comprised of a Business Office Specialists, Team Leads, Charge Entry Specialists, Payment Processing Specialists, Claims Resolution Specialists and Patient Services Coordinators. Each position is an integral component of the overall RCM team’s daily workflow. Team members are encouraged to cross train and learn how the function of each position works in conjunction with the whole RCM team.

This position is based in our Chapel Hill, NC office and is not eligible for telecommuting.

RCM Team Performance goals are set to achieve a first time claims pass-through goal of >98% and average receivables of <28 days.

Required/Preferred Skills and Proficiencies:

  • Maintaining AR for physician’s offices
  • Working denials received from Insurance companies
  • Research with insurance companies policies and procedures for proper claim management
  • Maintaining contact with insurance companies via phone and/or websites
  • Complete re-determinations or appeals
  • Adhere to metrics for daily production
  • Report trends for claim denials
  • Review LCD policies
  • Review denials based on modifiers/diagnoses codes
  • Prevent timely filing
  • Manage Errors in Availity to create claim edits in the system.
  • Cleans keying errors created by charge entry for additional training
  • Cleans claims for eligibility to ensure that the office is validating eligibility prior to seeing the patient
  • Maintains a list of all edits based on specialty and practice specific
  • Duties as assigned


  • NextGen EPM Software experience (preferred)
  • Knowledgeable in current procedural coder terminology and billing
  • Excellent organizational skills and detail oriented
  • Basic knowledge of Accounts Receivable and Financial Management
  • Ability to balance multiple priorities
  • Excellent interpersonal skills
  • Excellent English language oral and written communication skills, necessary to communicate effectively with coworkers over telephone/email and to accurately document correspondence
  • Ability to work independently as well as in a team environment
  • Possess strong problem solving skills
  • Ability to deal with stressful situations
  • Maintain a positive attitude
  • Professional, dependable, and punctual demeanor
  • Customer service oriented
  • DME/PT experience.

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