Job Summary:
The Billing Payer Response Analyst is responsible for review and correction of
claims rejected by the payer. This includes identifying trends and requesting updates to process and system master files to reduce future rejections by the payer.
Responsibilities:
- Review and timely resolution of payer claim rejections, including but not limited to claim resubmission and update of payer identification for the account.
- Documenting root cause of payer rejection for trending and staff education.
- Requesting process and/or system edit modifications to eliminate or reduce future payer claim rejections.
- Trending of payer rejections for delivery to Billing Manager and distribution to impacted departments.
- Practice and adhere to the “Code of Conduct” philosophy and “Mission and Value Statement”.
- Other duties as assigned.
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Skills and Experience:
- English – Spanish Language (Oral and writing 85% or higher), (B2+ or above).
- Must have a high school diploma.
- At least 1 year of experience in Customer Service or Backoffice positions.
- The resource will adjust its local schedule with the resources supporting this position during Daylight Savings time changes in the Eastern Time Zone.
- A genuine interest in working with and helping customers.
- Must possess excellent communication skills and involvement.
- Demonstrated experience in providing high levels of customer satisfaction and performance in a high transaction volume/high demand environment preferred.
- Good presentation and a polite, tactful, and friendly character.
- Healthcare experience is a plus.