Experienced with medical coding and billing practices, ensuring accurate patient data and claim submissions. Utilizes ICD-10, CPT, and HCPCS codes to optimize reimbursement processes. Track record of maintaining compliance with healthcare regulations and enhancing revenue cycle management.
· Responsible for reviewing hospital claims to verify proper reimbursement and work with stakeholders to resolve issues and optimize reimbursement processes while adhering to regulatory guidelines and organizational policies.
· Utilize company best practices along with technology enabled worklist and other internal tools to identify discrepancies between reimbursement and actual reimbursement amounts from insurance carriers.
· Demonstrate a commitment to upholding ethical standards and compliance with relevant regulations and guidelines in all reimbursement optimization activities.
· Actively participate in discussions, meetings, and brainstorming sessions where team members contribute insights and suggestions for improving processes.
· Investigate reasons for discrepancies, such as payment variances, coding errors, billing discrepancies, or incorrect application of payer policies.
· Contact insurance companies to obtain missing information, explain and resolve underpayments and arrange for payment or adjustment processing on behalf of client.
· Prepare and submit correspondence such as letters, emails, faxes, online inquiries, appeals, adjustments, reports and payment posting.
· Maintain through documentation, including root cause of underpayment issues, trends, outcomes, and lessons learned to support ongoing improvement efforts and knowledge sharing within the organization.