Clm Resltion Rep III, Hosp/Prv

Performs follow-up activities designed to bring all open account receivables to successful closure and conducts an effective claims follow-up to maximize revenue. Researches, corrects, and resubmits claims, submits appeals, and takes timely action to resolve unpaid or underpaid claims, including denied claims. Resolves complex claims, serves as a resource for lower level staff, and coordinates with payer representatives to verify insurance coverage and secure payment. Completes follow-up on denied/unpaid/underpaid accounts, reviews denial reasons, and documents actions. Works with leadership on communication to payer representatives regarding payment trends and issues, assists with Medicaid/Medicare credits, and conducts audits as needed. Scrubs and bills primary and secondary claims, identifies billing issues or variances, and supports related audits and reconciliations. Roles involves in-person training with remote work options within New York State after training, with occasional on-site meetings at the Rochester Tech Park area.