In my previous role, I encountered a denial due to a coding error. I reviewed the claim thoroughly, identified the incorrect code, and worked with the provider to correct it. I then resubmitted the claim, providing a detailed appeal letter explaining the correction and supporting documentation. The claim was approved within a week, saving the practice significant revenue loss.

I prioritize denials based on the potential financial impact and the urgency of the patient care. High-dollar claims and those affecting critical patient services are addressed first. I also consider the complexity of the denial, focusing on those that require immediate attention to prevent further delays in reimbursement.

I implement a thorough review process where claims are double-checked for accuracy before submission. I also maintain open communication with providers to ensure all necessary documentation is complete and compliant with payer requirements. Regular training sessions for the billing team help reinforce best practices and reduce errors.

If a denial is not resolved after the initial appeal, I escalate the issue by gathering additional supporting documentation and appealing to a higher authority within the payer organization. I also consult with legal or compliance teams if necessary to ensure all steps are taken to resolve the denial.

I have extensive experience working with various insurance payers, including Medicare, Medicaid, and private insurers. Each payer has unique denial management processes, and I stay updated on these by regularly reviewing their guidelines and participating in webinars or training sessions. This knowledge allows me to effectively navigate and resolve denials for each payer.