Accounts Receivable Resolution Specialist

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

Job Description :

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

Reviews and resolves claim rejections, denials, and appeals. Prepares secondary and tertiary claims as required.

Determines and verifies insurance coverage and coordination of benefits to support timely billing and follow-up when claims do not process or pay correctly. Obtains retro-authorizations as needed and when permitted.

Prepares and reviews billing reports, audits, and worklists; collaborates with multidisciplinary teams to ensure timely and accurate billing, re-billing, and charge corrections.

Communicates with patients when needed to verify insurance coverage and ensure coordination of benefits.

Demonstrates a strong understanding of payer requirements and organizational revenue cycle processes to support financial accuracy and compliance.

Scheduled Hours36 hours per week

LocationWaterville, Maine (Hathaway Building)

Scheduled Weekly Hours : 40

Scheduled Work Shift : Day (United States of America)

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. We know that our employees are our most valuable resource – they’re how we grow our business and care for our community.

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. Assistive technologies are available. Application assistance for those requesting reasonable accommodation to the career site is available by contacting HR at (207) 861-3440 . EEO is Law ()