|Responsible for investigating aged insurance claims to determine appropriate action and provide resolution; by determining payment status using account notes, health plan websites and health plan customer service. Determines and facilitates appropriate action for claim resolution and correct financial responsibility via DOFRs, IPA
and health plan contacts. Help to identify aged claim patterns to identify potential process improvements.
Perform timely follow up and collection on unpaid charges in appropriate EPIC WQs. Including research, re-billing, correcting, and/or appealing denied claims.
Review of erroneous denials and apply appropriate use and knowledge of coding guidelines for various specialties to correct claims.
Review correspondence and act as needed to supply health plans with required data (medical records, etc.).
Process refunds and adjustments through thorough research to ascertain whether or not refund appropriate.
Provide excellent customer service on telephone and written inquiries.
Any other task/duties/projects as assigned.