Follow up and investigate any denied, unpaid, or underpaid claims to determine reasons for discrepancies.

• Collaborate with respective team members/supervisors for resolution.
• Manage and maintain outstanding account balances to ensure accurate reporting of Accounts Receivable.
• Meet position's goals and objectives related to accuracy and productivity, i.e., days in Accounts Receivable, cash collections open claim count, reimbursement metrics, etc.
• Utilizes payer scorecards, identify high-risk accounts, and prioritizes follow-up efforts.

Work to ensure timely receipt and appropriate reimbursement.

• Work various systems and reports to ensure accurate classification of accounts and to ensure that all accounts have been billed and received by payers.
• Suggest billing component changes as necessary for payers.
  

Communicates directly with payers to follow up on outstanding claims, resolve payment variances, and achieve timely reimbursement.

• Address issues and clear barriers to payment.
• Utilize on-line/telephonic resources to verify benefits and to ensure claims are processed according to the appropriate benefit levels.
• Participates in continuous quality improvement efforts on an ongoing basis, establishing goals with supervisors and tracking progress.

Responsible for managing claim details and verifying accurate reimbursement.

• Initiate account adjustments and/or appeals on payment disputes.
• File appeals for denied claims and follow up as necessary through appeal resolution.
• Submit refund requests as necessary.

Additional Job Description:

Education/Training Requirements:

• Two years of business office experience in billing, customer service or collections is required. High school diploma or equivalent required
• Min of 1 year of relevant insurance experience in mental health or medical account resolution, collections or professional billing strongly preferred.
• Knowledge of claims review and analysis, along with a full understanding of healthcare explanation of benefits (EOB)
• Knowledge of all payer's insurance, self-pay after insurance, reimbursements, collections, appeals, claims follow- up.
• Experience with Cerner Revenue Cycle preferred.

Valid driver license. Must be granted insurable status by the Rogers Memorial Hospital insurance policy.