Clinical Revenue Cycle and Clinical Support Services
College of Dentistry (DN1032)
Finance/Real Estate/Procurement/Grant Management
Manage claims adjudication by identifying contractual variances between posted and expected reimbursement for Article 28, Managed Care, Commercial Insurance and other payers. Analyze, audit and recover outstanding receivables. Identify trends in payments, underpayment/overpayments and denials. Work with respective departments to evaluate trends and be part of the team that works towards resolution and improvement of the revenue cycle processes. Directly manage and resolve all assigned underpayment appeals, follow-up and payer relationships. Report to management any gross payment discrepancies by payers. Contact payer to resolve appeals and final solution to claims. Collaborate with the Director of Insurance Strategy in developing, implementing and maintain operational standards, providing guidance and direction relating to the performance of claims adjudication process. Train staff and administrators to support their adherence to existing and future changes relative to insurance guidelines.
Required Education: Bachelor’s degree
Preferred Education: Master’s degree in Business or Health Care Administration
Required Experience: 3 years’ relevant professional experience including reviewing and auditing insurance payments and denials, recommending policies and systems, and staff training or an equivalent combination of education and experience
Required Skills, Knowledge and Abilities: Knowledge of guidelines of managed care and claims guidelines and ability to identify trends/issues with denials and claims payments. Excellent analytical, communication and negotiation skills.