Responsibilities
- Track claims nearing filing deadlines and notify the revenue cycle management team to facilitate resolution and submission.
- Investigate reasons for payer rejections, communicate with payers directly, and take necessary actions to secure claim acceptance.
- Pursue unresolved claims by verifying their status with payers and confirming proper filing.
- Determine underlying causes for claim delays related to patient eligibility and coordinate with relevant teams to update coverage data.
- Analyze denial reasons, reach out to payers for clarification when needed, and file appeals within required timeframes.
- Maintain electronic data interchange enrollments including ERA and EFT with payers, resolve missing or failed transmissions, and initiate enrollment for newly in-network payers.
- Comply with payer-specific rules, federal and industry standards such as CMS billing requirements, NCQA guidelines, and delegated credentialing policies, while upholding internal compliance protocols.
- Drive process improvement projects within revenue cycle management, lead workflow enhancements, and implement changes to reduce denials and improve collections.
- Support the creation and execution of efficient procedures for billing, claims handling, revenue recovery, and cash application to ensure precision and timeliness.
- Partner cross-functionally with product, provider support, compliance, human resources, and finance teams to align revenue operations with organizational strategy.
- Adjust to shifting priorities and assume new responsibilities as the company and revenue cycle environment evolve.
