Prepare and submit accurate CMS-1500 claims to commercial, Medicare, Medicare Advantage, and Medicaid payers.
Review patient and insurance information for accuracy before claim submission.
Verify required authorizations and referrals before billing.
Submit claims through practice management systems and clearinghouses.
Monitor claim status through clearinghouses and payer portals.
Correct and resubmit rejected or denied claims.
Identify missing or incorrect information that may delay payment.
Ensure compliance with payer-specific timely filing requirements.
Maintain accurate billing records and documentation.

Verify patient eligibility and insurance benefits before services.
Review coverage, deductibles, copays, coinsurance, and authorization requirements.
Submit and track prior authorization requests.
Follow up with insurance companies on pending authorizations.
Document authorization details accurately in the practice management system.
Communicate coverage limitations and authorization issues to the appropriate team.

Post insurance payments, patient payments, adjustments, and contractual adjustments accurately.
Review EOBs and ERAs and reconcile payments against submitted claims.
Identify underpayments and payment discrepancies for investigation.
Assist in maintaining accurate patient account balances.

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