Claims Resolution Expert
1 day ago
As a Claims Resolution Expert at Mount Sinai Health System, you will be responsible for resolving EOB discrepancies and researching refunds. You will work closely with payer and provider representatives to negotiate higher rates for claim payments and ensure that collections, gross, days in A/R, and net collection ratios are met.
Key Responsibilities:
- Resolve EOB discrepancies and research refunds to ensure accurate payment.
- Negotiate higher rates for claim payments with payer and provider representatives.
- Monitor and analyze claims system reports to identify underpayments and collect from key carriers.
- Work declines and process appeals to resolve complex claim issues.
- Ensure established billing targets are met and maintain accurate records.
- Provide exceptional customer service to patients and third-party inquiries, resolving complex claims and correcting errors.
- Review correspondence and rejection data from insurance carriers and post rejections and perform reconciliations.
Requirements:
This role requires an Associate's degree or HS diploma/GED plus two years of related experience. 3 years of healthcare billing experience is preferred, with familiarity with CPT and ICD coding and CCI edits. Electronic claims processing experience is also desired.
Estimated Salary: $70,000 - $90,000 per year
Mount Sinai Health System offers a comprehensive benefits package, including medical, dental, and vision coverage, as well as a 401(k) plan and paid time off.
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