Clm Resltion Rep III, Hosp/Prv

Performs 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. Researches, corrects, resubmits claims, submits appeals and takes timely and routine action to resolve unpaid claims. Resolves complex claims. Acts as a resource for lower level staff.

Responsibilities

Completes follow up activities on denied, unpaid, or underpaid accounts; Contacts payer representatives to research and resubmit rejected claims; Reviews reasons for claim denial; Determines steps necessary to secure payment; Researches and calculates under or overpaid claims; Bills primary and secondary claims to insurance; Identifies and clarifies billing issues, payment variances, and/or trends; Assists department leadership with credit balances account reviews/resolutions and all audits; Coordinates response and resolution to Medicaid and Medicare credit balances; Reviews and works all insurance credits in electronic health record; Enters electronic health record notes; Researches and responds to third party correspondence; Receives phone calls and explains policies and procedures; Assists with patient related questions; Communicates and coordinates with other departments to resolve claim issues; Other duties as assigned

Requirements

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