Medical Billing | Insurance Verification | Denials & Appeals | Healthcare Client

As an AR follow-up and denial management specialist, I focus on identifying why a claim was denied by reviewing the EOB or ERA and contacting the insurance company to clarify the issue and determine the appropriate resolution. If the denial is due to a coding or documentation issue, I coordinate with the appropriate department to have it corrected. Once all necessary fixes are completed, I work with the claims team to proceed with either a corrected claim submission or a dispute or appeal, ensuring the claim is accurately resubmitted for reimbursement.

With 1-2 years of experience, I coordinate patient appointments and accurately collect and verify demographics, including personal and insurance information. By ensuring complete and correct data, I help prevent registration errors, reduce claim rejections, and support a smooth workflow from patient check-in through billing and reimbursement.

As a claims specialist, I verify the patient’s active coverage and eligibility on the date of service to prevent eligibility denials, identify their financial responsibility such as copay, deductible, and coinsurance, check for any authorization requirements and coverage limitations to avoid denials, and ensure that all information, including payer details, member ID, and coordination of benefits, is accurate to support a clean claim submission, ultimately helping reduce denials and speed up reimbursement.

claims management is the process of overseeing the entire lifecycle of a medical claim to ensure accurate and timely reimbursement. It involves submitting clean claims, monitoring claim status, identifying and resolving denials or rejections, and coordinating with payers and internal departments to correct any issues. The most important part of claims management is accuracy and attention to detail, as verifying coding, patient information, and payer requirements upfront helps prevent denials, reduces delays in payment, and ensures the provider receives proper reimbursement for services rendered.