Clm Resltion Rep II, Hosp/Prv

The claims resolution representative II is responsible for working across the professional fee organization, performing routine follow-up activities designed to bring all open account receivables to successful closure. Responsible for an effective claims follow-up to obtain maximum revenue collection. Responsibilities include but are not limited to researching, correcting, resubmitting claims, submitting appeals and taking timely and routine action to resolve unpaid claims. The Claims Resolution Representative II reports to Accounts Receivable Management.

Responsibilities

The claims resolution representative II is responsible for working across the professional fee organization, performing routine follow-up activities designed to bring all open account receivables to successful closure; Responsible for an effective claims follow-up to obtain maximum revenue collection; Responsibilities include but are not limited to researching, correcting, resubmitting claims, submitting appeals and taking timely and routine action to resolve unpaid claims; Follows up on denied accounts through review of remittances (EOBs), insurance correspondence, rejections received thru daily electronic and claims submission; Researches claims, identifies problems, and takes appropriate action to assure claim resolution; Responds to all billing-related inquiries from colleagues, departments, patients, and payors in a timely and professional manner; Follows established procedure for missing insurance payment information on claims; Escalates issues that may prevent completion of responsibilities to management; May perform other duties as assigned

Requirements

High School diploma and 2 years of related work experience required; Or equivalent combination of education and experience

Nice to have

Associate degree preferred; Ability to problem solve preferred; Excellent communication skills preferred; Ability to put information into a keyboard while typing min of 25 wpm preferred; Strong working knowledge of the professional billing software applications preferred; Excellent customer service skills preferred