• Performs retrospective coding review of denied charges for physician services. • Reviews medical records for completeness and accuracy to ensure documentation supports the services billed and all documentation standards are met for billing. • Make corrections to charges when necessary. • Analyze for invalid denial trends, payer specific carrier submission requirements & system optimization. • Performs extensive follow-up to investigate and resolve payment denial trends. • Resolves outstanding accounts utilizing ancillary applications and websites as tools to retrieve medical documentation. • Researches and interprets payer contract terms and compiles necessary supporting documentation templates for appeals. • Ensures denial reviews are conducted in a timely manner. • Maintains up-to-date policies and procedures and knowledge related to managed care and third party payors. • Participates in annual and on-going mandatory compliance training. • Fulfills Continuing Education Units necessary to maintain certification status. • Assists in training current and new employees on the use of systems and departmental policies and procedures. • Performs other related duties as assigned.

• Coordinates, completes, and monitors the provider/facility payer credentialing process • Processes credentialing and re-credentialing applications for health care providers • Sends, reviews, and verifies credentialing applications • Loads and maintains provider information in an online credentialing database system • Tracks license and certification expirations for medical staff to ensure timely renewals • Handles and resolves inquiries regarding credentialing information, process, or status

• Submit accurate claims for infusion therapies, injectable medications, and physician-administered drugs to insurance payers • Track claims to ensure timely processing and reimbursement • Identify and address claim rejections and denials promptly • Reconcile payments and outstanding balances for infusion and injectable drug claims • Maintain detailed records of payer communications and payment status • Confirm insurance eligibility and coverage for infusion therapies and physician-administered drugs • Collaborate with pharmacy and clinical teams to obtain prior authorizations when required • Ensure claims comply with payer policies, coding standards, and regulations • Maintain organized and accurate documentation for audit purposes • Identify opportunities to optimize the infusion and medical benefit drug billing process

• Position responsible for submitting and resolving medical claims moderate to high complexity. • Responds to requests from management, staff, or physicians in a timely and appropriate manner. • Maintains patient and physician confidentiality and professionalism at all times. • Follow department policies and procedures to ensure accurate and timely claim resolution. • Effectively communicates utilizing telephone, form letters, e-mail, or internal correspondence to resolve patient inquiries and insurance issues. • Attends and participates in team meetings. • Utilizes worklists to review and analyze account balances in order to collect payment for medical services rendered. • Utilizes multiple system applications to review, update patient information as well as research and resolve outstanding AR balance. • Assists in the analysis of claims resolution and provides feedback to management for solutions and process improvements. • Performs follow up with insurance companies to ensure appropriate payment on claims, resolve denials, correct claims, and appeal claims. • Acts as a liaison with internal and external customers providing assistance in claims and receivables resolution in a high volume environment. • Documents accounts with clear and concise verbiage in accordance with departmental procedures. • Reviews and responds to correspondence and inquiries received. • Meets and exceeds team productivity and quality standards. • Takes the lead on special projects. • Participates in staff training. • Reviews complex claims issues for resolution and recommends process improvements. • Performs other related duties as assigned.