Clm Resltion Rep II, Hosp/Prv

Job Title

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.

Essential Functions

With general direction of the Manager/Supervisor/Lead:

• Follows department policies and procedures and maintains and exercises thorough knowledge of insurance company billing requirements and regulations to research and resolve unpaid accounts receivables, making any corrections in the professional billing system necessary to ensure balance resolution for all assigned URMFG physician services.
• Follows up on denied accounts through review of remittances (EOBs), insurance correspondence, rejections received thru daily electronic and claims submission, etc. Research 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. Communicates any missing/incomplete information to providers and department administrative support staff to ensure accurate billing. Communicates with insurance representatives through telephone calls, payer website, and written communication to ensure accurate processing of claims.
• Follows established procedure for missing insurance payment information on claims. Keeps management informed of trends. Remains current on changes in billing requirements associated with claim processing and coding.
• Escalate issues that may prevent completion of responsibilities to management.
• May perform other duties as assigned.

Minimum Education & Experience (Required)

• High School Diploma and 2 years of related work experience
• or equivalent combination of education and/or experience

Knowledge, Skills and Abilities (Preferred)

• Strong working knowledge of the professional billing software applications
• Excellent customer service skills

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