Essential Functions

• Contact insurance carriers on a daily basis to follow up on/collect past due amounts on outstanding medical claims regarding denials or benefit changes.
• Maintain an accurate, up to date aging of assigned accounts including AR analysis and follow up.
• Keep educated on billing and medical policies for all payers.
• Have a working knowledge of In and Out of Network reimbursement processes/methodologies.
• Create and follow up on appeals needed to protest denials or incorrect payments.
• Review complex denials/tasks assigned by the payment posting team and resolve accordingly including reviewing refund requests, disputes and appeal as necessary.
• Work across all RCM departments to get issues related to claims payment resolved.
• Uphold and ensure compliance and attention to all company policies and procedures as well as the overall mission and values of the organization.
• Work with AR Supervisor to review/resolve open accounts as assigned.
• Perform other duties as assigned.
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Knowledge, Skills and Abilities

• High level of skill at building relationships and providing excellent customer service.
• Ability to utilize computers for data entry, research and information retrieval.
• Strong attention to detail and accuracy and multitasking.
• Must have highly developed problem-solving skills.
• Executes excellent customer service and professionalism when interacting with staff, payers, patients and families to ensure all are treated with kindness and respect.
• Through leadership and by example, ensures that services are provided in accordance with state and federal regulations, organizational policy, and accreditation/compliance requirements.
• Acts in accordance with CommUnityCare’s mission and values, while serving as a role model for ethical behavior.
• Promptly identify issues and reports them to their direct supervisor.
• Maintain regular and predictable attendance.
• Acts in accordance with CommunityCare's mission and values, while serving as a role model for ethical behavior
• Manage high volumes of work and organize/maintain a schedule independently.
• Must be able to effectively monitor steps in claims processing operations.
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