Job Description/Responsibilities:
Client & Payer Communication
- Serve as a point of contact for client billing questions and day-to-day requests
- Participate in client calls and internal meetings to discuss claim status, trends, and follow-ups
- Communicate directly with insurance payers via phone, secure portals, and correspondence
- Explain claim outcomes, rejections, and next steps to internal stakeholders and clients in clear, non-technical language
Claim Review & Issue Resolution
- Review claim rejections and denials that require analysis, interpretation, or payer clarification
- Identify patterns in rejections or denials and escalate trends to Account Managers
- Determine appropriate next steps for corrected claims, appeals, or documentation requests
- Perform quality checks on offshore team work to ensure accuracy and compliance before submission
Denial Strategy & Revenue Optimization
- Identify and work straight forward denials and rejections
- Complete more complex appeals as well as appeals that need to be submitted on paper
- Submission and review of claims for complex clients
Training, Guidance & Process Improvement
- Train offshore teams on client-specific rules, payer nuances, updated workflows and policies
- Support onboarding of new offshore staff
Onshore billing analysts provide:
- Client trust and confidence
- Financial and compliance accountability
- Strategic oversight and decision-making
- Clear communication and escalation ownership
- This role ensures that offshore efficiency is paired with onshore leadership, quality, and client satisfaction.