Overview

The Medical Biller is responsible for reviewing, analyzing, and resolving insurance payer denials to maximize revenue recovery and improve claim acceptance rates. This role focuses on denial resolution, appeals management, root-cause analysis, and collaboration with internal teams to reduce future denials and enhance billing efficiency.

Responsibilities

• Denial Review & Resolution
  • Review denial codes, Explanation of Benefits (EOBs), and payer correspondence.
  • Investigate denied claims and determine appropriate corrective actions, including corrected claim submission, appeals, or documentation requests.
  • Prepare and submit comprehensive appeal packets, including clinical documentation, appeal letters, and supporting evidence.
  • Follow up with payers to ensure timely resolution of denied claims.
• Root-Cause Analysis
  • Analyze and categorize denials, including coding, eligibi...