Accounts Resolution Specialist I - Ophth Clinical Support SEI

Responsibilities

• Facilitate activities necessary to a successful resolution of accounts.
• Handle claim edit work queue resolution.
• Follow up on work queue denials transferred from Professional Billing Office requiring department intervention.
• Investigate claim denials and underpayments by insurance carriers and appeal for payment or make appropriate adjustments.
• Escalate identified denial trends or root cause of denials to mitigate future denials, expedite the reprocessing of claims, and enhance front end claim edits to facilitate a first pass resolution.

Requirements

• Responsible for patient account research in relation to working accounts within the claim edit work queue and follow-up work queue.
• Maintain accuracy and timeliness in write-offs adhering to policy guidelines.
• Maintain high billing standards following current guidelines from Medicare, Medicaid, and other insurance entities.
• Answer revenue cycle patient inquiries and front desk questions regarding patient accounts.
• Meet or exceed established performance targets (productivity and quality) set by the Supervisor of Billing.

Qualifications

• H.S. Diploma/GED
• 3+ years working in healthcare (professional) billing, health insurance, or equivalent experience.