Position Summary

Manage claims adjudication by identifying contractual variances between posted and expected reimbursement for Article 28, Managed Care, Commercial Insurance and other payers. Analyze, audit and recover outstanding receivables. Identify trends in payments, underpayment/overpayments and denials. Work with respective departments to evaluate trends and be part of the team that works towards resolution and improvement of the revenue cycle processes. Directly manage and resolve all assigned underpayment appeals, follow-up and payer relationships. Report to management any gross payment discrepancies by payers. Contact payer to resolve appeals and final solution to claims. Collaborate with the Director of Insurance Strategy in developing, implementing and maintain operational standards, providing guidance and direction relating to the performance of claims adjudication process. Train staff and administrators to support their adherence to existing and future changes re...