Job Description
Description Follows up on claims with credit balances both patient and insurance balances using Explanation of Benefits (EOB). RCM Credits Specialist Lead has assigned specific books of business based on Financial Class and Payers. Work to support the field related to claim denials. Work with Credits Team to support, motivate, and unite through open communication and assistance with their accounts
7:30 AM
Log in and pull the overnight denial queue. Your worklist shows 40–80 claims flagged by the payer in the last 24 hours. Sort by do…
8:00 AM
Start working the queue. For each denial, you're reading the remittance advice, identifying the denial reason code (CO-4, CO-50, C…
9:30 AM
Hit a complex medical necessity denial from a Medicare Advantage plan. Open the patient chart, pull the clinical documentation, an…
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