About this role
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