Quadax Benefits Overview

Follows up with payers and patients on claim adjudication, resolves rejections, verifies eligibility and coordination of benefits, submits corrected or secondary claims, reviews payer correspondence, researches payment retractions, and monitors claim-processing trends. Maintains productivity and quality goals while handling confidential information and adapting to changing insurance policies and procedures.

Supervise billing department staff, coordinate assignments and staffing, monitor turnaround times, productivity, quality, and overtime, and conduct performance reviews. Resolve complex billing issues with insurance companies, support client meetings, communicate policy and SOP updates, coach employees, and recommend process improvements. Represent the department when the manager is absent and assist with planning resources to achieve departmental goals.

Processes insurance denials and submits timely appeals, external review requests, documentation, and appeal letters. Reviews EOBs, payer histories, case requirements, and state rules to develop appeal strategies. Coordinates consent, medical records, forms, phone hearings, and communications with patients, physicians, insurers, and state agencies. Maintains productivity and quality standards, meets filing deadlines, reports denial trends, answers calls as needed, and supports special projects.