Claim Resolution Rep IV

Performs follow-up activities designed to bring all open account receivables to successful closure and obtain maximum revenue collection. Researches, corrects, resubmits claims, submits appeals and takes timely and routine action to resolve unpaid claims. Mentors and trains new or lower level staff.

Responsibilities

Performs follow-up activities designed to bring all open account receivables to successful closure and obtain maximum revenue collection; Researches, corrects, resubmits claims, submits appeals and takes timely and routine action to resolve unpaid claims; Mentors and trains new or lower level staff; Independently determines the most effective method to follow up on disputed, unpaid, underpaid, or overpaid insurance or contracted service accounts; Researches and responds to clinical department inquiries on complex, high dollar, and specialized accounts; Resolves accounts identified in third party audits; Identifies need for in-person meetings and phone conferences with third party insurance representatives; Identifies and clarifies issues that require management and intervention to avoid loss of revenue; Researches and initiates suggestions to leadership to streamline processes and training materials

Requirements

Associate's degree and 3 years of relevant experience required; Or equivalent combination of education and experience; Remote location must be within 2 hours of RTP and within New York State