- Prepare, review, and submit clean medical claims to commercial payers.
- Verify claim accuracy, including coding, modifiers, eligibility, EAP authorizations, and provider details.
- Monitor claim rejections and take timely corrective actions.
- Manage denial resolution: research root cause, correct and resubmit, or prepare appeals.
- Conduct proactive follow-up on outstanding A/R and aging claims.
- Support patient billing activities and inquiries when needed.
- Document all billing activities clearly and accurately in internal systems.
- Ensure compliance with HIPAA, payer regulations, and state/federal billing guidelines.
- Collaborate with credentialing, eligibility/benefits, clinical operations, and internal RCM teammates.
- Identify trends and recommend process improvements to reduce denials and rework.
HIPAA