Responsible for ensuring that unpaid and partially paid claims are resolved in an efficient and timely manner. Resolves EOB discrepancies and researches refunds

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  Monitors and ensures that collections, net, gross and days in accounts receivable targets are met
• Follows up on submitted claims, monitors unpaid claims and resubmits claims with appropriate corrections and documentation
  Works declines, and processes appeals
• Ensures that established billing targets for collections, gross, days in A/R and net collection ratios are met
• May analyze claims system reports to ensure that underpayments are correctly identified and collected from key carriers
• Works with payer and provider representatives to negotiate higher rates for claim payments
• Responds to patient and third-party inquiries, researches and resolves complex claims and corrects errors
• Reviews correspondence and rejection data from insurance carriers; posts rejections and performs reconciliations
• May transfer secondary balances to appropriate financial class and provide documentation for processing the claims
• Reviews Credit Letter Sent (CLS) and transfers balance to appropriate financial class and dunning level
• May process refunds for supervisory approval
• Maintains strictest confidentiality; adheres to all HIPAA and Federal Payor guidelines and regulations
• Meets the daily productivity call and accounts
• Performs other related duties

• Familiarity with ICD9, ICD-10, preferred, CPT codes and DRG's
• Ability to analyze a UB04 and Explanation of Benefits
• Computer Skills: Must be proficient in Microsoft Outlook, Word and Excel
• Epic Knowledge a plus
• Prior office/call center preferred

• High school diploma or equivalent

• Associate or Bachelor’s degree from an accredited College or University

• 1+ year of previous experience preferred