Clm Resltion Rep IV, Hosp/Prv

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; Acts as a resource for questions from assigned collection and billing staff on payer policies, procedures and methods of revenue collection; Researches and responds to clinical department inquiries on complex, high dollar, and specialized accounts; Resolves accounts identified in third party audits involving retroactive approvals; 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