Denials Management and Claims Resolution in Coral Gables, Florida at Gastromed, LLC

Investigate, analyze, and resolve denied, rejected, and underpaid insurance claims. Prepare, submit, and track first-level and subsequent insurance appeals within payer deadlines. Review medical records, coding, documentation, and billing information to determine the cause of claim denials. Identify denial trends and recommend corrective actions to reduce future denials and improve reimbursement. Communicate with insurance companies to resolve claim payment issues and obtain claim status updates. Work collaboratively with providers, coders, billers, and authorization staff to resolve documentation, coding, and billing deficiencies. Request claim adjustments, corrected claims, or reconsiderations as appropriate to resolve outstanding balances. Monitor accounts receivable and prioritize denied claims based on aging and financial impact. Maintain accurate and detailed account notes and documentation within the billing system. Ensure all denial and appeal activities comply with payer guidelines and regulatory requirements. Prepare denial management and appeals activity reports for the Revenue Cycle Manager. Assist with identifying process improvements to enhance claim acceptance rates and reduce reimbursement delays. Perform other duties as assigned by management.

• Successful completion of a criminal background check.
• Successful completion of professional reference checks.

We offer a competitive salary and a comprehensive benefits package, including:

• 100% employer-paid employee health insurance
• Dental Insurance
• Vision Insurance
• Life Insurance
• 401(k) Retirement Plan
• Paid Time Off (PTO)
• Paid Holidays