We represent a number of successful state - wide health information exchanges, all -
payer claims databases and related initiatives, as well as advise on national HIT infrastructure projects and issues associated with electronic health records.
• Working knowledge of ICD - 9 and ICD - 10 and OASIS • Excellent skills in reviewing delinquent accounts and creating avenues for overdue payments • Demonstrated expertise in translating medical procedures into codes that can be easily translated by
payers and medical facilities • Proficient in appropriately and confidentially handling patient treatment, diagnosis and procedural information • Well - versed in investigating rejected
claims and ensuring that they are resubmitted and paid • Special talent for investigating insurance fraud and determining ways to counter / avoid sticky situations • Skilled in verifying and completing charge information in company defined
databases • Familiar with documentation needs (and manners of obtaining them) for insurance
claims submission and approval • Qualified to work efficiently with external collection agencies to ensure maximization of reimbursement • Particularly effective in handling appeals for denials by employing exceptional knowledge of carriers and appeal processes • Special talent for increasing reimbursements by investigating denied
claims and providing alternatives to denials