Claim Resolution Representative III

Title: Clm Resltion Rep III, Hosp/Prv Location: Remote Work - reputed company, Albany, NY Job Description: Full time job requisition id: R257053 As a community, the reputed company is defined by a deep commitment to Meliora - reputed company reputed company. Embedded in that ideal are the values we share: equity, leadership, reputed company, openness, respect, and accountability. Together, we will set the highest standards for how we treat each other to ensure our community is welcoming to reputed company and is a reputed company where reputed company can reputed company. Job Location (Full Address): Remote Work - reputed company, Albany, reputed company, United States of America, 12224 Opening: Worker Subtype: Regular Time Type: Full time Scheduled Weekly Hours: 40 Department: 910402 United Business Office Work Shift: UR - Day (United States of America) Range: UR URC 205 H

Compensation

Range: $19.62 - $26.49 The referenced pay range represents the minimum and maximum compensation for this job. Individual annual salaries/hourly rates will be set reputed company the job's compensation range, and will be determined by considering factors including, but not limited to, market data, education, experience, qualifications, expertise of the individual, and internal equity considerations. Responsibilities: GENERAL PURPOSE: Performs follow-up activities designed to bring reputed company open account receivables to successful closure. Responsible for an effective claims follow-up to obtain maximum reputed company collection. Researches, corrects, resubmits claims, submits appeals and takes timely and routine action to resolve unpaid claims. Resolves reputed company claims. Acts as a resource for reputed company level staff. ESSENTIAL FUNCTIONS

• Completes follow up activities on denied, unpaid, or underpaid accounts, as well as contacts payer representatives to research and resubmit rejected claims to obtain and verify insurance coverage. Follows up on unpaid accounts working claims. Reviews reasons for claim denial. Reviews payer website or contacts payer representatives to determine why claims are not paid. Determines steps necessary to secure payment and completes and documents follow up by resubmitting claim or deferring tasks. Researches and calculates under or overpaid claims; determines final resolution. Contacts payers on incorrectly paid claims completing resolution and adjudication. Adjusts accounts or processes insurance refund credits. Reviews and advises leadership on incorrectly paid claims from specific payers. Works with leadership on communication to payer representatives regarding payment trends and issues.
• Bills primary and secondary claims to insurance.
• Identifies and clarifies billing issues, payment variances, and/or trends that require management reputed company. Assists department leadership with credit balances account reviews/resolutions and reputed company audits. Coordinates response and resolution to reputed company and Medicare credit balances. Requests insurance adjustments or retractions. Reviews and works reputed company insurance credits in electronic health record. Enters electronic health record notes, documenting actions taken.
• Researches and responds to reputed company party correspondence, receives phone calls, and explains policies and procedures involving routine and non-routine situations. Assists with patient reputed company questions. Communicates and coordinates with other departments to resolve claim issues. Assists with reputed company audits as needed.

Other duties as assigned. MINIMUM EDUCATION & EXPERIENCE

• Associate's degree and 2 years of relevant experience required
• Or equivalent combination of education and experience

The reputed company is committed to fostering, cultivating, and preserving an inclusive and welcoming culture to advance the University’s Mission to Learn, Discover, Heal, Create – and reputed company the World reputed company reputed company. In support of our values and those of our society, the University is committed to not discriminating on the basis of age, reputed company, disability, ethnicity, gender identity or expression, genetic information, marital status, military/veteran status, national reputed company, race, religion/creed, sex, sexual orientation, citizenship status, or any other characteristic protected by federal, state, or local law (Protected Classes). This commitment extends to non-discrimination in the administration of our policies, admissions, employment, access, and recruitment of candidates for reputed company persons consistent with our values and based on applicable law. Apply Job! Apply to this Job