• Responsible for researching and resolving outstanding balances by following up on claim status, working denials, and filing appeals. • Manage the end-to-end A/R workflow including billing, payment posting, adjustments, reconciliation, claim follow-up, and resolution. • Ensure timely and accurate submission of claims across commercial, Medicare, Medicaid, and managed care payers. • Reconcile payments, remittances (ERA/EOB), and correct posting discrepancies when applicable. • Conduct detailed review of denied or underpaid claims to determine root causes and corrective actions. • Prepare and submit persuasive appeal letters supported by documentation and regulatory guidelines. • Track and analyze denial patterns, escalating systemic issues to leadership and recommending process improvements. • Collaborate with payers to clarify claim decisions, request reconsiderations, and resolve administrative or coding-related barriers. • Communicate with insurance carriers via phone, email, fax, and portal correspondence to resolve outstanding issues. • Maintain professional, timely communication with internal teams and clients regarding claim status, trends, and financial impacts. • Build strong relationships with payer representatives to improve overall reimbursement efficiency. • Apply current federal and state regulations that impact reimbursement, including Medicare/Medicaid guidelines. • Review and resolve EDI rejections, claim edits, and submission errors. • Utilize automation tools, RPA workflows, and AI-enabled processes to streamline follow-up and improve productivity. • Maintain accurate documentation and meet or exceed established productivity and quality benchmarks.