• Capture necessary registration details such as demographics, insurance coverage and clinical documentation.
  • Screen patients for required level of benefits and any necessary pre-certification/authorization.
  • Work directly with multiple insurance websites to obtain benefits and authorization validation.
  • Collection of diagnosis and procedure codes required for medical claims submission.
  • Actively review patient accounts ensuring claims are accurate and billable. Identify and resolve claim edits through understanding of billing guidelines and payer requirements.
  • Comply with third party regulatory mandated requirements for billing and collections.
    Timely Filing
  • Ensure medical claims are filed in accordance with the time frame outlined in the payers’ contracts.
  • Variance/Underpayments
  • Ensure reimbursement is consistent to the terms outlined in the payers’ contracts.
  • Denials/Appeals
  • Proactively fix claim rejection errors and resubmit claims based on payer requirements.
  • Analyze billing and third-party payments, adjustments and denials for appropriateness.
  • Maintaining accurate, clear and concise account notes and other relevant data for the tracking and trending of payer behaviors.
  • Based on analytics of payer behaviors, providing continual feedback for the adaptation of processes and procedures to maximize client revenues and bottom-line results.
  • Professional and courteous customer service inquiry management.
  • Patient payment collections and payment plans establishment.

Do you have questions? Ask us anything!