Job Description

Job Description

To ensure that denied, rejected, or underpaid insurance claims are corrected and resubmitted accurately and promptly to maximize reimbursement for healthcare services

Responsibilities

The post holder will:

• Analyze the rejections
• Clarifying the Rejection queries to the Insurance Company
• Doing Resubmission production for assigned facility with quality.
• Sharing rejection feedback to the Submission team
• Sharing rejection feedback to the Approval team
• Sharing rejection feedback to the reception team.
• Facilities doubt clearing (Coding, insurance Queries)
• Monthly team meeting in sharing the ideas regarding insurance rejection.
• Sharing rejection updates to medical auditor to share with respective doctor.
• Supporting submission team for their queries
• Providing justification for reconciliation claims.

Qualifications

• College Diploma – Any discipline or related fields. 
• Coding Certification, CPC – Certified Professional Coder (AAPC)

Proficiency in:

• ICD-10-CM (diagnosis codes)
• CPT (procedure codes)

HCPCS Level II (supplies, equipment, services)