• Review and process all BC/BS and Commercial high dollar claims (over $10,000) for denials, payor issues and payment trends. • Submit, process and track all appeals for BC/BS and commercial payors. Maintain knowledge of ERISA laws governing employee benefit plans and manage the appeal process for these claims. • Assist A/R staff with complex claim issues they are unable to resolve in a timely manner. • Track and trend all Single Case Agreements. Work closely with Contracting on any SCA payment issues / concerns. • Review payments for BC/BS and commercial payors for rate validation according to our contracts. • Track all denial outcomes for payment, write-offs and transfers to client liability. Identify the root cause for the adjustments to client accounts. Work with management to review adjustment trends and identify potential solutions. • Help maintain integrity of accounts receivable ledger, including aged receivable monitoring on an ongoing basis. • Responsible for maintaining current knowledge of revenue components including benefit plans, contract terms and rates and billing forms and codes. • Check status of claims through use of telephone, websites and/or other means available. • Document adjustments needed to patient accounts. • As needed, participate in phone conference calls with payors. • Pursue collection activities and follow up for balances outside of established norms. • Coordinate collection activities with outside agencies, including court appearances, as needed. • Provide feedback & education management with regards to issues that impact revenue flow. • Provide appropriate documentation and reports designed to assist in fiscal management of the agency. • Serve as a member of the SWAT Team and participate in team meetings. • Serve as a member of the Revenue Cycle Team and participate in all team meetings and activities. • Understand and comply with all of the principles established by the Rosecrance Corporate Compliance Program and Code of Ethics. • Perform all responsibilities in compliance with the mission, vision, values and expectations of Rosecrance. • Deliver exceptional customer service consistently to every customer. • Serve as a role model for other staff, clients and customers and demonstrate positive guest relations in representing Rosecrance. • Assume other related responsibilities as assigned by management.