Clm Resltion Rep III, Hosp/Prv
Core
Manages follow-up activities to resolve open accounts receivable, denied, unpaid, or underpaid insurance claims for a hospital/provider setting.
Role type
Claims Resolution Representative
Builds
Resolved claims and collected revenue for the University of Rochester health system
Domain
Healthcare administration / Insurance billing
Required skills
Claims adjudication, Insurance billing, Payer communication, Claim resubmission, Appeals processing, Account adjustment, Credit balance resolution, Audit coordination, Policy interpretation, Data entry
Technologies
Electronic health record systems
Responsibilities
Researches and resubmits rejected claims to obtain insurance coverage; Reviews reasons for claim denial and determines steps to secure payment; Bills primary and secondary claims to insurance; Identifies and clarifies billing issues and payment variances; Coordinates response and resolution to Medicaid and Medicare credit balances; Enters notes into electronic health record documenting actions taken; Communicates with payer representatives regarding payment trends and issues.
Seniority
Mid-level, individual contributor