Accounts Receivable Resolution Specialist-2

Revenue Cycle Operations Specialist

Applies knowledge of organizational revenue cycle operations to achieve key performance indicators. Processes accurate payer claims to ensure timely reimbursement and resolves denials or incorrect payments from insurance carriers.

Prepares bills in paper and / or electronic formats according to departmental and payer guidelines, ensuring proper transmission and compliance. Reviews and edits claims for accuracy prior to submission, verifying correct diagnosis and procedure codes.

Reviews and resolves claim rejections, denials, and appeals. Prepares secondary and tertiary claims as required to ensure complete reimbursement. Determines and verifies insurance coverage and coordination of benefits to facilitate timely billing and follow-up when claims do not process or pay correctly. Obtains retro-authorizations as needed and permitted.

Prepares and reviews billing reports, audits, and worklists; collaborates with multidisciplinary teams to ensure accurate billing, re-billing, and charge corrections. Communicates with patients when necessary to confirm insurance information and ensure coordination of benefits.

Demonstrates strong analytical and problem-solving skills in identifying trends, reducing denials, and improving claim resolution processes.

Scheduled Hours : Full-Time Location : Waterville, Maine (Hathaway Building) Scheduled Weekly Hours : 40 Scheduled Work Shift : Job Exempt : No

Benefits : Supporting all aspects of our employees' wellness physical, emotional and financial is a critical component of being a great place to work. With the wide range of benefits and programs available, employees have the resources they need to be well at every stage of life and plan for the future.

Physical Wellness : We offer quality health, dental, and vision benefits and wellness programs and resources to provide employees access to resources for a healthy lifestyle and help manage health care costs. Employees have access to industry-leading leave for new parents. A generous earned time plan is offered to all employees - We believe employees need and deserve time away from work to observe holidays, be with family, go on vacation, or simply take care of themselves.

Emotional Wellness : When life gets challenging, employees have access to our Employee Assistance Program for employees and anyone in their household.

Financial Wellness : An employee discount program is available to all employees for services provided by MaineGeneral Medical Center. Tuition Reimbursement is available to all employees to further develop skills and career. We offer eligible employees up to 2% of eligible pay in 403(b) company-matching contributions plus another 2% in the 401(a) retirement income plan. Three insurance plans are available to protect your family from the sudden loss of income in the event of your death, terminal illness or serious injury from accident. We offer both short-term and long-term disability insurance to replace a portion of your income if you become disabled and cannot work for a period of time.

Career Mobility : Helping our employees develop their skills and grow their careers is critical to how we retain our talent and sustain our business. We do this by offering our teammates a variety of leadership-supported programs and learning and development resources for every stage of their professional development.

Equal Opportunity Employer M / F / Vet / Disability Assistive technologies are available. Application assistance for those requesting reasonable accommodation to the career site is available by contacting HR at 207-861-3440. Equal Opportunity Employer M / F / Vet / Disability : In furtherance of MaineGeneral's policy regarding Equal Employment Opportunity, MaineGeneral has developed a written Affirmative Action Program which sets forth the policies, practices and procedures that MaineGeneral is committed to in order to ensure that its policy of nondiscrimination and affirmative action is accomplished. The Affirmative Action Plan for Veterans and Individuals with Disabilities is available for inspection by any employee or candidate for employment upon request, during normal business hours, in the Human Resources Department. EEO is Law (https : / / www.dol.gov / ofccp / regs / compliance / posters / pdf / eeopost.pdf)