• Comprehensive research and review to resolve payer claim denials. • Researches payer denials related to referral, pre-authorization, notifications, medical necessity, non-covered services, and billing resulting in denials and delays in payment. • Requires extensive knowledge of carrier specific claim appeal guidelines. • Conducts comprehensive reviews of the claim denial and makes determinations if an authorization needs to be obtained, a written appeal is needed, or if no action is needed. • Writes and submits professionally written detailed appeals which include compelling arguments based on clinical documentation, third-party medical policies, and contract language. • Customize appeals to payers in accordance with Medicare, Medicaid, and third-party guidelines as well as VitalConnect policies and procedures. • Possesses proven analytical and decision-making skills to determine what selective clinical information must be submitted to properly appeal the denial. • Contact payers, via website, payer portal, phone and/or correspondence, regarding reimbursement of claims. • Understands medical billing requirements for Medicare, Medicaid, contracted, in-network, out of network and commercial payers. • Strong understanding of insurance plans (HMO, PPO, IPO, etc.), coordination of benefits, medical terminology, limited coverage and utilization guidelines, denial remark codes and timely filing guidelines. • Responsible for tracking and trending of recovery efforts by utilizing various departmental tools and appropriately reporting on-going problems specific to payers and/or contracts. • Ensuring all eligible accounts are appealed within the designated payer time frames and are documented appropriately in the patient software system. • Consistently meet the current productivity standards in taking appropriate actions to identify and track root causes, successfully appeal denied accounts, and trend issues. • Must be cross trained and functional in all areas within the department as it relates to A/R and denials. • Extensive working knowledge with insurance explanation of benefits (EOB) and comprehensive understanding of remittance and remark codes. • Experience accessing payer portals such as Navinet, Availity, etc.to obtain information and upload appeals, etc. • Provide individual contribution to the overall team effort of achieving the department A/R goal. • Escalate exhausted accounts that will not be financially cleared as outlined by department policy to management. • Contact payers to determine cause of denial and steps to appeal. • Perform follow-up activities indicated by relevant management reports. • Review daily payer correspondence to proactively reconcile denials in a timely manner. • Maintains confidentiality of patient's financial and medical records; adheres to the State and Federal laws regulating collection in healthcare; adheres to enterprise and other regulatory confidentiality policies; and advises management of any potential compliance issues immediately. • Communicate with all internal and external customers effectively and courteously. • Maintain patient confidentiality, including but not limited to, compliance with HIPAA. • Perform other related duties as assigned or required.