Follow up on hospital billing claims (IP/OP/ER) with insurance payers.
Manage aging AR (30/60/90/120+ days) and high-value hospital accounts.
Analyze and resolve claim denials and rejections related to coding errors, DRG/APC issues, authorization & medical necessity, bundling, duplicate claims, timely filing, and eligibility.
Contact insurance companies through calls and payer portals for claim status and resolution.
Correct errors and resubmit UB-04 claims with appropriate documentation.
Prepare and submit appeals with medical records and supporting documents as required.
Ensure compliance with payer guidelines and hospital billing regulations.
Coordinate with coding, clinical, and billing teams to resolve claim issues.
Maintain accurate documentation and updates in billing systems.
Meet productivity, quality, and turnaround time (TAT) targets.
Identify denial trends and suggest process improvement measures.
