Confirm patient coverage with payer.

Check active/inactive status, plan type, copays, deductibles, and prior authorization needs.

Obtain prior authorization for services/procedures if required.

Provider documents diagnosis, procedures, and medical necessity.

Ensure completeness and accuracy for coding.

Convert provider documentation into ICD-10, CPT, and HCPCS codes.

Ensure codes meet payer guidelines and compliance standards.

Enter charges into practice management/billing system.

Match charges with correct codes and modifiers.

Clean claims are submitted electronically to insurance payers.

Electronic Remittance Advice (ERAs) are posted in system.

Patient responsibility is updated.

Analyze denied/rejected claims.

Correct and resubmit or appeal as needed.

Generate patient statements for remaining balances.

Follow up via reminders, calls, or payment plans.

Track KPIs (Days in A/R, First Pass Resolution Rate, Denial Rate).

Identify revenue leakage, optimize coding, and improve workflow.