Review and audit medical claims to ensure accuracy, completeness, and compliance with payer requirements.
Manage the resubmission of rejected claims, ensuring all necessary corrections and supporting documentation are provided.
Ensure adherence to agreed pricing lists, provider manuals, and insurance company guidelines when billing services to respective payers.
Communicate claim rejections to Billing Officers in a timely manner and implement corrective actions to minimize future occurrences.
Coordinate with physicians and other stakeholders to obtain clinical justifications and supporting documentation for claim resubmissions when required.
Submit claims using appropriate coding standards and formats within the stipulated timelines established by insurance companies.
Maintain compliance with regulatory requirements, payer policies, and organizational standards related to medical claims processing...