Job Overview
Provide mentoring to Account Resolution Specialists (ARS) I and II. Ensure proper claim submission and payment for hospital and physician claims through review and correction of claim edits, errors, and denials. Utilize review and payer guidelines.

Job Duties and Responsibilities
•Acts as a mentor to assigned ARS team for hospital and physician claims.
•Provides ongoing feedback on ARS performance to improve productivity.
•Submits hospital claims in accordance with Federal, State, and payer-mandated guidelines.
•Comply with productivity standards while maintaining quality levels.
•Responsible to research, analyze, and review hospital and physician claim errors and rejections and make applicable corrections.
•Ensures that claims submitted to payers are not returned nor denied due to controllable error.
•Maintains required knowledge of payer updates and process modifications to ensure accurate claims.
•Investigate, follow up with payers, and collect on insurance accounts receivables.
•Escalate stalled hospital and physician claims.
•Verify hospital accounts display accurate liability and balance with payer.
•Identify any payer-specific issues and communicate to team and manager.
•Lead and contribute to daily shift briefings.
•Review employee scorecards daily and provide coaching to employees if not meeting key metrics.
•Escalate employee deficiency to manager, if coaching attempts have failed.
•Research problem accounts.
•Escalate client IPO issues to manager, if not resolved internally.

Qualifications
•High school diploma or equivalent
•Experience working with health insurance companies securing payment for medical claims
•Experience with billing hospital, physician, and professional claims (UB04)
•Experience filing appeals with health insurance companies.
•Two plus years of experience in medical billing or follow-up with hospitals using claim form UB04.
•Proficiency with computers including Microsoft Office Suite/Teams and GoToMeeting/Zoom, etc.
•Experience with Epic