Process of gathering patient demographic and insurance information accurately. Verification of patient eligibility and coverage to ensure proper reimbursement.

Assigning accurate and appropriate medical codes to diagnoses, procedures, and services. Ensuring compliance with coding guidelines and regulations.

Preparation and submission of e-claims to payers. Tracking & monitoring the status of claims, following up on denials. Resubmitting and appealing claims.

Generating patient statements and invoices. Managing accounts receivable and monitoring outstanding balances.
Handling inquiries and resolving billing-related issues.

Posting and reconciling payments received from patients and insurance payers. Identifying and addressing payment discrepancies or errors.

Identifying denials and finding the reasons for rejection. Analyzing denial trends and implementing strategies to avoid future denials. Preparing and submitting appeals .

Generating reports on key revenue cycle metrics, such as days in accounts receivable, collection rates, and reimbursement trends. Analyzing data to identify areas for improvement and optimize revenue cycle performance.

Ensuring adherence to healthcare regulations (e.g., HIPAA, Stark Law) and payer guidelines. Implementing processes and controls to mitigate compliance risks.

Utilizing revenue cycle management software and technology tools to streamline processes and improve efficiency. Integration with electronic health record (EHR) systems and other healthcare software.