01Overview
Key Roles & Responsibilities
- Review and analyze denied, rejected, and underpaid hospital claims.
- Contact insurance companies via calls to determine claim status and denial reasons.
- Investigate authorization, eligibility, coding, medical necessity, duplicate, and billing-related denials.
- Work on denial corrections, claim resubmissions, and reconsiderations.
- Prepare and submit appeals with supporting documentation when required.
- Follow up on outstanding accounts receivable to ensure timely reimbursement.
- Utilize payer portals, IVR systems, and billing software to research claims.
- Maintain accurate documentation of all actions taken on accounts.
- Escalate complex denials to appropriate internal teams when necessary.
- Identify recurring denial trends and recommend process improvements.
- Meet productivity, quality, and collection targets as defined by the client.
- Ensure compliance with HIPAA, payer guidelines, and hospital billing policies .
