My experiences in Revenue Cycle Management are as follows:
Medical Billing/Charge Entry - Checking raw claims from yesterday's appointment and checking if the units and modifiers were correct and accurate. Check billing errors/rejections. Check Trizetto clearing house to investigate why the claim was sent electronically but not received by the insurance.
Claims Status/AR Follow-up - Checking claims via portal or phone call. Investigate denial and resolve according to guidelines. Submit appeal/reconsideration for claims to be paid or overturn denials. Make sure all previous dates must be worked first to avoid loss of revenue.
Authorization and Referral - checking new patient accounts' eligibility and if the specific clinic or doctor is contracted with the plan. Check authorization if required. If required, make sure to check for HMOs (referral from the PCP) and for authorization if the service would need authorization.
Insurance Verification - check eligibility via portal or on IVR/Phone call.
Payment Posting - checking all ACH, Self-Pay, and mailed EOBs so the payment will be posted on the patient's account for a specific dos should be keen to numbers and details to avoid incorrect balances to patients.
