What You'll Do
Resolve complex insurance claims by investigating denials, correcting errors, and resubmitting for payment. Take ownership of unpaid or underpaid accounts, ensuring follow-up actions are completed efficiently to maximize revenue recovery. Serve as a go-to resource for less experienced staff, offering guidance on claims resolution processes.
Contact insurance payers to verify coverage, clarify rejections, and advocate for claim approvals. Research and validate reasons for non-payment by reviewing payer policies and electronic records. Determine the appropriate steps to secure payment, whether through resubmission, appeals, or adjustments, and document all actions within the system.
Analyze underpaid or overpaid claims, calculate discrepancies, and finalize resolution in alignment with policy. Manage credit balances related to Medicaid and Medicare, coordinating responses and corrections as needed. Process insurance refunds and adjust accounts accurately to maintain financial integrity.
Collaborate with department leadership to address recurring billing issues, payment variances, and trends affecting collections. Support audits by providing documentation and insights into claim history and resolution outcomes. Respond to third-party inquiries, explain financial policies, and coordinate with internal teams to resolve cross-departmental issues.
Requirements
- Associate’s degree and two years of relevant experience, or an equivalent combination of education and experience
- Proven ability to interpret insurance responses, resolve claim denials, and navigate payer systems
- Skill in researching, calculating, and adjusting claims for accurate reimbursement
- Experience documenting actions in electronic health records and working within compliance frameworks
- Strong communication skills for interacting with payers, colleagues, and leadership
Benefits
This hybrid position offers flexibility with both remote and on-site work options, supporting a balanced approach to productivity and collaboration. Compensation ranges from $19.62 to $26.49 per hour, based on experience and qualifications. The work environment emphasizes equity, respect, and accountability, fostering professional growth and meaningful contribution to organizational goals.
