Roles and Responsibilities:
- Review and analyze denied claims to identify reasons for denial and assign appropriate ICD-10, CPT, and HCPCS codes.
- Resolve coding-related denials by making necessary corrections and ensuring compliance with payer-specific guidelines.
- Work closely with billing and accounts receivable teams to resubmit corrected claims promptly.
- Investigate trends in claim rejections and implement strategies to minimize denial rates.
- Liaise with healthcare providers and teams to clarify documentation discrepancies affecting claim approvals.
- Ensure claims meet industry standards and payer-specific policies for successful reimbursement.
- Maintain accurate records of denial cases and resolutions for reporting purposes.
- Stay up to date on coding guidelines, healthcare regulations, and payer policy updates.
- Meet productivity and quality benchmarks established by the organization.
- Maintain confidentiality and adhere to HIPAA regulations in handling patient information.
Skills Required
Cpc, Cpt, Radiology, Icd