1. Claim Creation and Submission
- Preparing and submitting claims (CMS-1500 or UB-04) to insurance companies.
- Ensuring accuracy in ICD-10, CPT, and HCPCS coding to minimize claim rejections.
- Submitting claims through payer portals or clearinghouses.
2. Payment Posting
- Posting insurance payments, patient payments, and adjustments with accuracy.
- Reconciling EOBs (Explanation of Benefits) and ERAs (Electronic Remittance Advice).
- Handling overpayments, underpayments, and credit balances.
3. Insurance Verification
- Verifying patient eligibility and benefits before appointments.
- Checking copay, deductible, and coverage limits.
- Coordinating pre-authorization or prior approvals for procedures.
4. Denial Management
- Identifying reasons for claim denials and rejections.
- Correcting errors and resubmitting claims.
- Preparing appeals to challenge denied claims effectively.
5. AR (Accounts Receivable) Follow-Up
- Working on aged claims and contacting ins