I have over three years of experience in handling contract reimbursement processes, including reviewing contracts, verifying billing accuracy, and ensuring compliance with payer requirements. My role involved coordinating between healthcare providers and insurance companies to resolve discrepancies, which honed my attention to detail and understanding of complex reimbursement structures. I am proficient in using various billing software and have a strong grasp of medical coding, which ensures accurate and timely reimbursements.

To ensure accuracy, I meticulously review each claim against the contract terms and verify all supporting documentation. I use checklists and automated tools to catch discrepancies and stay updated on payer policies and coding updates. My approach involves double-checking calculations and consulting with team members or supervisors when in doubt, which minimizes errors and ensures compliance with regulatory standards.

Once, I noticed a recurring underpayment for a specific service. Upon investigation, I discovered the payer was using outdated rates. I compiled evidence, including contract excerpts and payment histories, and presented it to the payer. After persistent follow-ups, the payer acknowledged the error and issued corrected payments. This experience taught me the importance of vigilance and effective communication in resolving reimbursement issues.

I prioritize tasks based on deadlines and complexity, using digital tools like spreadsheets and project management software to track progress. I allocate specific times for reviewing claims, responding to queries, and following up on pending items. This systematic approach, combined with regular updates to stakeholders, ensures timely processing and reduces the risk of overlooked claims.

I analyze the denial reason, review the claim and contract details, and gather necessary documentation for appeal. I then prepare a clear, concise appeal letter, highlighting the justification for reconsideration. If needed, I engage in discussions with the payer to clarify misunderstandings. My goal is to resolve disputes amicably while ensuring the organization receives due reimbursements.