Clm Resltion Rep III, Hosp/Prv
Core
Resolves complex medical insurance claims, follows up on denied/unpaid accounts, and ensures maximum revenue collection for patient financial services.
Role type
Senior claims resolution representative (medical billing)
Builds
Closed accounts receivable and resolved insurance adjudications
Domain
Healthcare / Medical Billing
Required skills
Claims adjudication, insurance coverage verification, payer communication, claim resubmission, appeal management, account adjustment, audit coordination, electronic health record management, Medicaid/Medicare billing, policy interpretation
Preferred skills
Experience with complex claim variances, trend analysis for leadership reporting, multi-payer billing systems
Technologies
Electronic health records, billing software, payer portals
Responsibilities
Researches and resubmits rejected claims to obtain insurance coverage; resolves complex claims and acts as a resource for lower-level staff; bills primary and secondary claims to insurance; identifies and clarifies billing issues and payment variances; responds to third-party correspondence and explains policies; coordinates responses to audits and credit balance resolutions.
Seniority
Mid-level, hands-on IC