JOB DESCRIPTION

Job holder is responsible for the identification, mitigation, and prevention of denials along with preparing reports on clinical disputes based on the criteria documented. Assists with day-to-day revenue cycle denial operations and support process improvement initiatives for coding, billing, and collections activities associated with Denial Prevention.

RESPONSIBILITIES

• Monitors compliance of rules and the contractual terms and agreement with insurance companies and DOH Guidelines.


• Ensures compliance by the facility pricing structure and the rules for the different patient categories (including self‑payer) with implementation.


• Prepares submission for all patient invoices (claims) electronically.


• Maintains and reports incorrect charges and charges not captured to Team Billing Lead or Billing Manager. Bills all secondary claims processed on a daily basis that are produc...