Accounts Receivable, Hospital billing

Key Responsibilities:

• Follow up on hospital billing claims (IP/OP/ER) with insurance payers.
• Manage aging AR (30/60/90/120+ days) and high-value hospital accounts.
• Analyze and resolve claim denials and rejections related to coding errors, DRG/APC issues, authorization & medical necessity, bundling, duplicate claims, timely filing, and eligibility.
• Contact insurance companies through calls and payer portals for claim status and resolution.
• Correct errors and resubmit UB-04 claims with appropriate documentation.
• Prepare and submit appeals with medical records and supporting documents as required.
• Ensure compliance with payer guidelines and hospital billing regulations.
• Coordinate with coding, clinical, and billing teams to resolve claim issues.
• Maintain accurate documentation and updates in billing systems.
• Meet productivity, quality, and turnaround time (TAT) targets.
• Identify denial trends and suggest process improvement measures.