Overpayment Handling: Validate setup and reasons (duplicate, COB, fee schedule), verify claims (paid vs. allowed), determine recovery method (refund or recoup/offset), track timelines, document, and follow up until resolved.
Appeals & Documentation: Confirm appeal receipt and level, review attached clinical/claim documents, track workflow stage, and request missing records via secure channels.
Claim Lifecycle Management: Monitor claims from receipt to payment/denial, ensure proper documentation (EOBs, notes), and attach all records for reprocessing or appeal review.
Customer Service: Handle inbound inquiries professionally, resolve issues on first contact when possible, escalate complex cases, maintain clear communication, and ensure customer satisfaction through follow-ups.
Collaboration & Performance: Share best practices, contribute to process improvements, and support teammates; recognized for high-quality, customer-focused performance.
Resolution & Communication: Identify fixes (corrected claim, docs, overrides), provide clear case summaries (dates, billed vs. allowed, adjustments), and send EOB/ERA securely with reference numbers, next steps, timelines, and compliance disclosures.
