The Billing Agent/Subject Matter Expert (SME) plays a critical role in supporting a U.S. healthcare client by researching, entering data, and processing or adjusting healthcare appeals and claims across multiple systems and tracking tools. This position requires applying deep process knowledge to identify, assess, and resolve complex issues. As a recognized SME, the individual will troubleshoot and advise on processing guidelines, ensuring compliance with client standards. The role involves handling both standard and non-standard issues and escalating tasks outside established SOPs when necessary.
Key Responsibilities
Research and process healthcare appeals and claims using multiple systems and tracking tools.
Validate claim accuracy and ensure compliance with regulatory requirements.
Perform root cause analysis for claim discrepancies and implement corrective actions.
Enter accurate data into designated platforms following client processes.
Apply knowledge of healthcare processes and systems to resolve complex issues.
Troubleshoot and provide guidance on processing guidelines as needed.
Identify and escalate issues outside standard operating procedures.
Maintain compliance with client-specific workflows and documentation standards.
Collaborate with internal teams to ensure timely resolution of claims and appeals.
Monitor and report on claim status and processing metrics.