The specialist performs retrospective coding reviews of denied physician charges and investigates payment denial trends to resolve outstanding accounts. They also prepare robust appeals by reviewing medical records and ensuring documentation supports the services billed.
The role involves managing self-pay patient accounts, resolving billing discrepancies, and performing follow-ups on insurance claims and denials. Additionally, the specialist will provide customer service, establish payment plans, and assist in training staff on departmental policies.
The role involves developing and managing database assets, including Snowflake and SQL data marts, to support business analytics and Power BI dashboards. Additionally, the developer will create automation solutions, manage application design, and serve as a technical lead for reporting and data analysis services.
Investigate and resolve coding-related insurance payment denials by performing retrospective reviews of medical records. Write robust appeals to defend medical necessity and identify root causes of denial trends to improve clinical documentation.
Develop complete ETL data flow models and backend objects to create complex business intelligence reports. Document solution directions and technical specifications to enhance the end-user experience and meet business requirements.
Manage a high volume of self-pay patient accounts to ensure prompt payment and resolve account discrepancies. Act as a liaison for professional services billing and assist in training staff on departmental policies and systems.
