Claim Denials

Led successful implementation of AR Console & 835 automation, streamlining claims linkage & payment posting.

Established department KPIs for claim follow-up, increasing transparency and accountability in claims management

Led weekly huddles focused on addressing denials & rejections, resulting in improved first-pass resolution rates.

Developed SOPs & month-end checklists to ensure timely & complete claim submission post-close.

Coordinated denial analysis & trend tracking to address systemic issues impacting claim processing.

Collaborated with payers & internal teams to streamline appeal processes & reduce repeat denials.

Developed denial tracking workflows for analysis and resolution.

Led Six Sigma CQI initiatives focused on reducing preventable denials & optimizing denial appeal workflows.

Improved first-pass claim resolution by addressing front-end & charge capture denial triggers through SOP alignment & staff training