Description

Ensure full reimbursement is received by the client for clinical services rendered including professional, long-term/home care and hospital care, by effectively and accurately managing a receivable. Resolve edits to ensure accurate claims are sent to primary and secondary insurances. Research and resolve denials and payer requests for information promptly and accurately in order to secure payment. Work as part of a dynamic team continually looking for ways to improve a complex business process.

Key Responsibilities:

oReview and accurately process claim edits in a system work queue. Accurately handle claim adjustments and coverage changes as needed.

o Review and process claim denials according to established processes. Research and resolve denial issues via the payer website, coverage policies and/or phone calls to the payer. Submit corrected claims and appeals.

o Process account adjustments and refunds as needed according to departme...