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 .
