The Payment Specialist works independently and is responsible for the analysis and interpretation of complex contract language to identify and determine maximum reimbursement. Applies independent judgment and knowledge to audit third-party payer payment disputes. Documents and/or notifies management of preventive measures in response to payment trends identified through analysis of claims denial data. Works with management staff identifying corrective measures necessary to resolve denial problems. Understands and utilizes many complex and varying California and Federal Statutes and regulations, guidelines and systems to ensure appropriate billing and collections are in compliance. The Payment Specialist will manage resources responsibly.
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