• Review claims, insurance responses, EOBs/ERAs, payer correspondence, and other billing
information to identify outstanding issues affecting payment.
• Monitor accounts receivable and aging reports to identify unpaid, denied, underpaid, or
otherwise unresolved claims requiring follow-up.
• Investigate the underlying reason for claim denials, rejections, non-payments, or
underpayments and determine the appropriate next steps for resolution.
• Work directly with our third-party billing company to research outstanding claims, communicate
needed corrections or additional information, and ensure appropriate follow-up is completed.
• Follow claims through the revenue cycle, including corrected claims, resubmissions,
reconsiderations, appeals, and other payer follow-up as appropriate.
• Review and research documentation, coding, authorization, eligibility, medical necessity, and
payer-related issues contributing to claim denials or delayed reimbursement.
• Assist with appeals and denial resolution by gathering supporting medical documentation,
coding information, and other necessary records.
• Communicate with physicians, clinical staff, administrative team members, and the billing
company to obtain information needed to resolve coding, documentation, or reimbursement
issues.
• Identify recurring billing, coding, or claims issues and communicate trends to leadership to
help improve processes and prevent future denials or payment delays.
• Maintain accurate and timely documentation of billing and claim follow-up activities within the
appropriate systems.
• Utilize Electronic Medical Records (specifically eClinical Works), payer portals, billing systems,
Microsoft Office, and other technology to research, document, and resolve revenue-cycle
issues.
• Protect patient information and maintain strict compliance with HIPAA and PHI requirements.
• Assist with other billing, coding, revenue-cycle, and administrative projects as assigned.
Qualifications
Education & Experience:
● High school diploma or equivalent required; associate degree or additional
healthcare/business education preferred.