Description
1. Analyzes medical claims to assure they are complete and accurate and have any required attachments before being filed to payer (clean claim).
2. Expedites proper adjudication of claims by payer to maximize reimbursement and minimize older age accounts. Identifies claims that have not been adjudicated and assures they are adjudicated promptly.
Analyzes reason given for claim not being adjudicated and how we might overcome lack of adjudication.
3. Reviews adjudicated claims to assure they were properly adjudicated with the proper payment amount and to assure that unpaid amounts are valid and properly categorized.
Appeals claims that are improperly adjudicated so they are promptly corrected.
4. Identifies problems and patterns, quantifies, reports and resolves problems.
5. Establishes effective working relationships with internal and external customers to expedite creation of clean claims and prompt and proper adjudication of claims.
Communicates technical information accurately and effectively whether in writing or orally. Excellent ability to think on feet.
6. Performs other duties as assigned.
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