We Offer the following services

 · Reduce outstanding account receivables by managing claims inventory which includes reviewing A/R report monthly for denied insurance claims over 60, 90, 120 and older claims.

· Responsible for claims follow-up, Professional and Facility, from claim submission until final payment

 · Communicate with insurance companies regarding claim denials or underpayments  

· Utilize Payer Online Portals such as Availity, Cigna, UHC, Emblem, epaces, for claims status and eligibility verification

. Send Medical Records to payers, filing reconsideration and appeals

. Utilize providers EMR's to obtain Medical Records

. Reading and understanding various payers EOB's

. Communicating with 3rd party payers such as Multiplan, MARS and Zelis regarding OON claim negotiations

. Follow up on Pre-negotiated Agreements

. Utilize medical collection systems to track and collect payments

. Ensure compliance with all relevant coding and billing regulations

. Effectively resolve complex issues, including payment research, payment recoupments

. Effectively communicate issues to management, including payer, system or escalated account issues as well as develop solutions

. Knowledge in multi-Specialty coding-CPT and ICD codes for many different specialties

· Worked with the following payers, Health First, Fidelis, Aetna, Cigna, Metro Plus-Beacon, Blue Cross Blue Shield-Excellus-Anthem plans, Medicaid/Medicaid HMO plans, Medicare/Advantage plans, UHC, Meritain Health, SGIC, Amida Care, GHI-Emblem, Evercare Choice, Humana, Kaiser, Molina, Multi-Plan, MVP, Oscar insurance, Univera Healthcare, Sun Health, and Prime Health Choice.