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Operations & Automation Specialist

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Operations

Claims & Payment Reconciliation

I prepared insurer claims, checked tariffs, followed up on queries and corrected invoices. I matched payments to submitted claims and tracked outstanding balances.

Tools: Excel. Illustrative records protect patient and business confidentiality. Click any image to enlarge.

I reviewed billed amounts, payments and outstanding balances by insurer and month. Overpayments were tracked separately.

I reviewed billed amounts, payments and outstanding balances by insurer and month. Overpayments were tracked separately.

I maintained insurer-specific tariffs so the same service was billed at the correct agreed rate.

I maintained insurer-specific tariffs so the same service was billed at the correct agreed rate.

I checked each service, quantity and tariff before preparing the claim total.

I checked each service, quantity and tariff before preparing the claim total.

I recorded insurer remittances and checked that each payment was fully allocated.

I recorded insurer remittances and checked that each payment was fully allocated.

I matched payments to claims, including payments covering several claims, and recorded short payments and rate differences.

I matched payments to claims, including payments covering several claims, and recorded short payments and rate differences.

I tracked insurer queries, missing information and invoice corrections through to resubmission.

I tracked insurer queries, missing information and invoice corrections through to resubmission.

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