- Improve first-pass claim acceptance by ensuring correct coding and flagging inconsistencies.
- Review EOBs and denial trends to identify and implement solutions.
- Partner with vendors to translate requirements into tools and update clinical workflows.
- Resolve claim issues in collaboration with billing team and senior management.
- Review clinical documentation (SOAP notes) and perform CPT/ICD-10 coding for complex cases.
- Maintain reference guides for coding corrections.
- Ensure alignment with CMS, state Medicaid, and managed-care guidelines.
- Monitor payer policy changes and ensure optimized billing practices.
- Collaborate on the implementation of new payer contracts.
EHRHIPAA