- Engage daily with market leaders to assist with denials requiring local intervention.
- Review and respond to escalated emails and facilitate appeals.
- Train new colleagues on follow-up processes to ensure proficiency.
- Review clinical documentation and obtain medical necessity support for payer appeals.
- Manage underpayment reports and lead overpayment report reviews and refund submissions.
- Collaborate with Prior Authorization, Contracting, and Credentialing teams to resolve denials.
- Perform QA for payment posting, insurance follow-up, coding, and financial counseling.
Microsoft OfficeQuality Assurance