Responsibilities
- Oversee accounts receivable by analyzing aging reports and identifying underlying causes of delays, recommending billing rules or system edits to prevent recurring errors
- Handle denial management by investigating reasons for denials, resolving issues, and filing appeals, including direct communication with insurance payers
- Exercise independent judgment in adjusting claims, resubmitting corrected claims, and applying appropriate resolution strategies
- Coordinate with internal departments such as Performance, Operations, and Sales, as well as clinical care center personnel when necessary
- Assist in preparing for and supporting the launch of large care centers
- Partner with the Revenue Optimization team to verify payments align with contract terms and conduct denial reviews using the Trizetto platform
- Engage directly with practice consultants or physicians to maintain efficient revenue cycle operations
- Contribute to meeting daily and monthly departmental Key Performance Indicators (KPIs)
- Perform additional tasks as assigned by management
