Job Description:
• Review denied claims to identify root causes, missing information, or billing discrepancies.
• Analyze payer rejection and denial trends to support reporting and process improvement.
• Research and compile supporting documentation, including medical records, account details, policies, and procedural information.
• Prepare, submit, and track appeals and reconsideration requests with insurance carriers and third-party organizations.
• Maintain productivity by handling high-volume appeals and follow-up activities daily.
• Coordinate with insurance carriers and payer representatives via phone, email, and online portals to resolve disputes.
• Communicate with healthcare providers and internal departments regarding billing details, treatment plans, claim status, and documentation requirements.
• Monitor appeal statuses and ensure timely follow-up on pending requests.
• Maintain complete and accurate records of appeals, correspondence, and outcomes in internal systems.
• Collaborate with billing, coding, customer support, clinical, and operations teams to support accurate claim processing.
• Handle an estimated workload of 60% outbound calls and 40% back-office tasks.
• Follow payer guidelines, reimbursement policies, HIPAA standards, and company compliance requirements.
Qualifications:
• Has working knowledge in healthcare revenue cycle, ICD-10 coding, accounts receivable, and insurance appeals processes.
• Accurate documentation and data entry skills with close attention to claim details and supporting records.
• Shows ability to manage multiple priorities while meeting deadlines and productivity expectations.
• Shows ability to work independently and collaborate with cross-functional teams.
• Clear and coherent both written and verbal communication skills in English.
Screening Criteria:
• High school diploma or equivalent combination of education and work experience.
• Minimum of three (3) years of healthcare billing, medical claims management, or revenue cycle experience.
• Experience handling denied claims, appeals, and payer communications.
• Must have stable employment history.
