Senior Analyst, Risk Adjustment Data Integrity & Payor Submissions
denials, data discrepancies (e.g., mismatched subscriber IDs, invalid TINs, missing DOS), and unbilled/rebill workflows...
denials, data discrepancies (e.g., mismatched subscriber IDs, invalid TINs, missing DOS), and unbilled/rebill workflows...
with third party payers. Review claims issues and make corrections as needed and rebill. Utilize claims clearing house...
and resolve edits preventing timely claim billing Analyze aging worklists to contact payers, obtain claim status, and rebill...
with credit and rebill activity, customer returns, and other adjustments as needed. Reconcile customer accounts and research...
discounts and write-off’s. Monitor unpaid accounts and takes appropriate action (i.e. rebill, submit to the guarantor, phone...
Troubleshoot and resolve billing rejections and subsequently rebill claims to appropriate carriers for all commercial, federal...
of facility invoices and rebill claims as necessary. Assist with prior authorization and non-formulary worksheets and process...
is needed or payer agrees to reprocess claim. Request rebill/corrections if denial has been reviewed and it is determined that a rebill...
recognition, and financial impacts Validate billing adjustments, reversals, cancel/rebill processing, and account corrections...
and rebill transactions as needed Enter new parts, process recalls, and warranty claims Support campaign creation and rollout...