- Review and analyze delayed or denied claims to determine root cause based on payer explanation of benefits or remittance advice.
- Conduct timely follow up with insurance carriers to clarify claim status, resolve issues, and secure payment.
- Obtain missing information, correct coding or billing errors, and submit corrected claims or resubmissions when appropriate.
- Research and interpret payer coverage policies, contracts, and medical necessity requirements related to molecular and NGS testing.
- Document all follow up activity, payer communication, and resolution steps accurately and timely within the billing system.
- Partner closely with prior authorization, billing, reimbursement, and client services teams to resolve claim discrepancies.
- Manage incoming single-case agreements or LOAs and negotiate appropriate reimbursement rates.
Microsoft Office SuiteHIPAA