Billing Rejection Specialist

Key Responsibilities

• Clearinghouse Monitoring: Daily review and management of clearinghouse portals to capture, sort, and action front-end rejections.

• Direct Payer Communication: Contact insurance companies directly via phone or web portals to investigate complex claim rejections, verify active patient eligibility, and check benefit coverage details.

• Root Cause Analysis: Investigate why claims were rejected by the clearinghouse or payer, distinguishing between demographic errors, missing insurance details, coding discrepancies, and provider credentialing mismatches.

• Claim Correction & Resubmission: Efficiently update and correct patient demographics, insurance policy numbers, CPT/ICD-10 codes, and modifiers within the practice management or EHR software before resubmitting.

• Cross-Functional Collaboration: Partner with internal staff and internal medical coders to address data capture errors and help prevent recurring rejections.

• Tracking & Reporting: Maintain accurate logs of rejected claims, common rejection trends, and resolution turnaround times, providing visibility to billing management.