The Claims Resolution Representative II supports the professional fee organization by performing routine follow-up activities to resolve open accounts receivable and maximize revenue collection.
This role is responsible for researching, correcting, resubmitting claims, submitting appeals, and taking timely action to resolve unpaid claims. The position reports to Accounts Receivable Management and works under the general direction of a manager, supervisor, or lead.
Key responsibilities
- Research and resolve unpaid accounts receivable using insurance company billing requirements and regulations.
- Review denied accounts through remittances, EOBs, insurance correspondence, rejections, and claim submission results.
- Research claims, identify issues, and take appropriate action to ensure claim resolution.
- Respond to billing-related inquiries from colleagues, departments, patients, and payors.
- Communicate missing or incomplete information to providers and administrative staff to support accurate billing.
- Work with insurance representatives by phone, payer websites, and written correspondence.
- Follow procedures for missing insurance payment information and keep management informed of trends.
- Stay current on billing requirement changes related to claim processing and coding.
- Escalate issues that may prevent completion of responsibilities.
- Perform other duties as assigned.
Requirements & Qualifications
Minimum education and experience
- High school diploma and 2 years of related work experience required.
- Associate degree preferred.
- Equivalent combination of education and experience accepted.
Knowledge, skills, and abilities
- Ability to problem solve.
- Excellent communication skills.
- Ability to type at least 25 words per minute.
- Strong working knowledge of professional billing software applications.
- Excellent customer service skills.
Location
New York, US
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
Yes
Posted
1 week ago