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The Role
Manage hospital claim denials by investigating denial reasons, contacting payers, correcting and resubmitting claims, preparing appeals, using payer portals/IVR/billing software, documenting actions, escalating complex issues, and identifying process improvements to meet collection and quality targets while ensuring HIPAA compliance.
Summary Generated by Built In
Key Roles & Responsibilities
- Review and analyze denied, rejected, and underpaid hospital claims.
- Contact insurance companies via calls to determine claim status and denial reasons.
- Investigate authorization, eligibility, coding, medical necessity, duplicate, and billing-related denials.
- Work on denial corrections, claim resubmissions, and reconsiderations.
- Prepare and submit appeals with supporting documentation when required.
- Follow up on outstanding accounts receivable to ensure timely reimbursement.
- Utilize payer portals, IVR systems, and billing software to research claims.
- Maintain accurate documentation of all actions taken on accounts.
- Escalate complex denials to appropriate internal teams when necessary.
- Identify recurring denial trends and recommend process improvements.
- Meet productivity, quality, and collection targets as defined by the client.
- Ensure compliance with HIPAA, payer guidelines, and hospital billing policies
Skills Required
- Experience reviewing and analyzing denied, rejected, and underpaid hospital claims
- Proven experience contacting insurance companies via phone to determine claim status and denial reasons
- Experience investigating authorization, eligibility, coding, medical necessity, duplicate, and billing-related denials
- Experience performing denial corrections, claim resubmissions, and reconsiderations
- Experience preparing and submitting appeals with supporting documentation
- Experience following up on outstanding accounts receivable to ensure timely reimbursement
- Experience using payer portals, IVR systems, and billing software
- Ability to maintain accurate documentation of all actions taken on accounts
- Knowledge of HIPAA, payer guidelines, and hospital billing policies
- Ability to identify recurring denial trends and recommend process improvements
- Ability to meet productivity, quality, and collection targets
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The Company
What We Do
GetixHealth provides hospitals, clinics, university medical centers, and other healthcare facilities across the United States with comprehensive revenue cycle management (RCM) services. Our services are customized to the needs of our client and can either include all facets of the front and back office revenue cycle or a mixture of these services, including but not limited to: medical coding and billing, claims management, insurance eligibility services, medicaid/medicare specialized services, and self pay and bad debt collections.
