Opportunity Description
Key Responsibilities
- 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...
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