The role is responsible for submitting, editing, correcting, and researching claims to ensure clean adjudication payment from all payors.
What Would You Do? The Specifics.
- Prepares and generates clean claims for submission to all payor types, including third party payors, Medicare and Medicaid. Submissions of claims to be are done via 837 electronic, CMS-1500, fax, and online web portal.
- Processes an average of 20-25 claims per hour.
- Facilitates all rejections from electronic or paper claims. Obtains information from carriers, stores, internal entities or patients when services billed are denied for reasons such as incorrect insurance information, demographic information and/or authorization. Appeals denials when necessary.
- Develops and maintains working relationships with internal/external providers to ensure billings and collections procedures are current.
- Researches and resolves all zero payment explanations or benefits and exercises all options to obtain claims payments; initiates adjustments as necessary.