Conducts follow up activities with our Government and 3rd Party Payers to ensure prompt reimbursement to the Organization. Analyzes rejected claims to determine cause of denial and initiates appropriate action needed in order to adjudicate claims. Communicates with Hospital/Practice personnel, external organizations and payers to determine and obtain missing, incomplete or required documentation. Uses all available tools in order to work efficiently and expedite claim adjudication including payer portals, work queues and Work Bench reports.
Minimum Knowledge, Skills, and Abilities Required
High School graduate or certification from an accredited Career School.
Working knowledge of CPT, HCPCS, Revenue and ICD9/10 codes.
2-3 years claims resolution experience in a Practice/Hospital Patient Accounts office.
Interpersonal and communication skills necessary to effectively interact with peers and Government/3rd Party Payers.
Knowledge of the rules and regulations as they relate to Government and 3rd Party Payers.
Strong analytical skills necessary to identify and resolve complex claim issues.
Proficiency in computer skills including Excel, Word and Access database applications.
MaineHealth System - 7 months ago
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