Insurance

• Review complex claims, patient records and hospital and physician billing practices to identify discrepancies or errors in Medicare payments
• Retrieve and properly identify documents from Revenue Cycle Management (RCM) system and update tracking and billing systems
• Perform internal and external data, files, or medical chart reviews to ensure codes billed are supported and comply with CMS guidelines and medical policies
• Complete, review, and research deficiencies and consult with physicians/clinicians and staff on documentation and regulatory issues
• Develop and manage relationships with colleagues and report anomalies and trends to Supervisor
• Conduct special projects, reconcile and review medical necessity, and prepare spreadsheets and summary reports
• Prepare complex claims reimbursement submissions in managed care environment and assess risk of denial, audit, or retraction
• Advocate and support clinic administration on reimbursement and managed care, maintain relationships with customers and insurance organizations
• Provide training to field staff on reimbursement issues and process complex claims accurately

Priority Claims Specialist III

Client Assurance Resolution Leader

Insurance Verification Representative

Field Insurance Inspector

Senior Manager, Insurance Product Analysis

Health Insurance Liaison