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Senior Collections Representative
3 months ago
The person in this position will be responsible to monitor and research cases that are in-house and on the discharged not final billed report to mitigate any potential denials and ensure that claims are clean before billing. Individual will work closely with Clinical Resource Management (CRM) to ensure cases reflect the correct clinical level of care and ensure clinical information is received by the insurance carrier for timely level of care authorizations by the payers. Monitor and report payer authorization delays and stall tactics as they occur . Follow-up with all insurance carriers to facilitate timely andcorrect reimbursement for high balance cases. Investigate and report reasons for non-payment and delays. Perform root cause analysis of the various trends identified. Write appeals to recover denied and underpaid claims. Support payer escalation process by being able to ensure high balance cases are prepared for outsourcing to attorney . Gather documentation and summarize issues for attorney .
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