Clm Resltion Rep III, Hosp/Prv

The Claims Resolution Representative III is responsible for working across the professional fee organization, handling follow-up activities designed to bring all open accounts receivable to successful closure. Responsible for effective claims follow-up on complex, multi-faceted accounts to obtain maximum revenue collection and closure. Responsibilities include, but are not limited to, independent research, claim correction and resubmission, handling payer specific appeal process taking timely and routine action to resolve unpaid claims. The Claims Resolution Representative III reports to Accounts Receivable Management.

Responsibilities

Follows department policies and procedures and maintains and exercises comprehensive knowledge of insurance company billing requirements and regulations to research and resolve unpaid accounts receivable, making any corrections in the professional billing system necessary to ensure balance resolution for all assigned URMFG physician services; Follows up on multi-faceted denials through review of remittances (EOBs), insurance correspondence, rejections received thru daily electronic and claims submission, etc.; Responds to all billing-related inquiries from colleagues, departments, patients, and payors in a timely and professional manner; Keeps management informed of changes in billing requirements and rejection or denial codes as they pertain to claim processing and coding; Collaborates with Claim Edit Specialists and Patient Medical Billing Specialists assigned to pre claim WQ's to identify opportunities for improvement in clean claims rate; May perform other duties as assigned

Requirements

Associate's degree and 2 years of relevant experience; Or equivalent combination of education and experience

Nice to have

Excellent problem-solving skills; Excellent communication skills; Excellent customer service skills; Strong working knowledge of the professional billing software applications; Ability to type 25 wpm