Responsible for reviewing, correcting, and reprocessing insurance claims that were previously denied, underpaid, or processed incorrectly. The role focuses on ensuring claims are compliant with payer guidelines, contractual agreements, and internal policies to maximize accurate reimbursement.
Key Responsibilities:
Analyze denied, rejected, or incorrectly processed claims to identify root causes
Rework and resubmit claims with accurate coding, charges, and supporting documentation
Review Explanation of Benefits (EOBs) and remittance advice for discrepancies
Ensure compliance with payer policies, billing rules, and turnaround time (TAT) standards
Coordinate with billing, coding, and provider teams to resolve claim issues
Track rework trends and recommend process improvements to reduce future denials
Maintain detailed documentation and follow up until final claim resolution
