Insurance

• Initiates insurance follow-up on unresolved appealed or unpaid claims to ensure maximum and timely reimbursement for Medicare, Medicaid, Commercial, or Specialty insurance/program payors, focusing on complex insurance denials.
• Verify patient benefits and insurance eligibility, perform claims status verification, navigate insurance websites for payor guidelines, and communicate findings to insurance companies, management teams, and clinical departments.
• Assist the customer service team in resolving high-complexity and/or escalated patient billing concerns or disputes.
• Review and respond to insurance correspondence related to recoupments, refunds, eligibility, or additional requests from payors.
• Analyze daily claim rejections, screen claims for pre-authorization, and request and submit medical records.
• Work closely with the team to manage high-complexity work queues and claims; lead special projects and streamline workflows.
• Meet or exceed production standards to resolve outstanding claims and maintain healthy accounts receivable.
• Handle requests from Coding, Payment Posting, Managed Care Operations, Provider Enrollment, and Clinical Operations to resolve claims and patient or provider issues.
• Serve as the liaison between affiliated hospitals and organizations to maximize collection efforts.

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