ED Facility

Roles and Responsibilities

1. Patient Registration & Verification

Collect patient details during emergency visits

Verify insurance eligibility and coverage

2. Medical Coding (ED Cases)

Assign accurate CPT, ICD codes for emergency treatments

Ensure coding is compliant with guidelines

3. Charge Entry

Enter all services, procedures, and doctor charges into billing system

Ensure no missed charges (like labs, injections, scans)

4. Claim Submission

Prepare and submit claims to insurance companies (like Medicare/Medicaid or private payers)

Ensure claims are clean and error-free

5. Denial Management (AR Caller Role)

Analyze denied claims related to ED services

Call insurance companies to resolve issues

Work on reprocessing or resubmission

6. Payment Posting

Post payments received from insurance and patients

Adjust contractual differences if needed

7. Follow-ups

Regular follow-up on pending claims

Track unpaid or underpaid claims

8. Compliance & Documentation

Ensure all records meet healthcare regulations (HIPAA)

Maintain proper documentation for audits