Key Responsibilities:

Accounts Receivable (AR) Follow-Up

Monitor and manage assigned accounts receivable, ensuring timely follow-up on unpaid claims to reduce AR days.

Contact insurance companies, patients, or other stakeholders to resolve payment issues and secure outstanding payments.

Review aging reports regularly to prioritize high-dollar and aged claims, ensuring prompt action on delayed reimbursements.

Denial Management and Resolution

Analyze denied claims to identify reasons for denial and develop corrective actions for each case.

Research and gather supporting documentation to resubmit or appeal denied claims, ensuring compliance with payer requirements.

Work closely with billing and coding teams to address coding or documentation issues contributing to denials and prevent future occurrences.

Claim Reconciliation and Documentation

Ensure accurate claim reconciliation by confirming payments are posted correctly and identifying discrepancies for resolution.

Maintain comprehensive records of follow-up actions, denials, appeals, and resolutions for tracking and reporting purposes.

Update patient accounts and internal systems to reflect the latest status of claims and any adjustments made.

Performance Monitoring and Reporting

Track and report on AR metrics, including denial rates, AR aging, and claim resolution timelines, providing insights to management on trends and areas for improvement.

Contribute to monthly or quarterly AR performance reviews, highlighting successes and identifying opportunities for process improvements.

Participate in audits and quality assurance initiatives, ensuring compliance with industry standards and payer guidelines.

Collaboration and Process Improvement

Collaborate with the billing, coding, and client services teams to address root causes of denials, such as coding inaccuracies or missing documentation.

Provide feedback to RCM leadership on denial trends and suggest improvements to reduce recurring issues, contributing to overall process optimization.

Stay updated on payer requirements, industry trends, and regulatory changes to ensure claims and appeals meet current standards.