As a Provider Claims/Appeals Processor, I handle the review and adjudication of medical claims to ensure providers are reimbursed correctly based on insurance policies and coding guidelines. I verify patient eligibility, benefits, and coding accuracy, and I investigate any claim issues such as missing documents, coding errors, or duplicate submissions. I also review denied or underpaid claims and overpayments.
My role requires strong attention to detail, compliance with HIPAA and payer regulations, and accurate documentation to ensure claims are resolved efficiently and on time.
