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Successful Insurance Claims Processing
Spend less time fighting denials and more time ensuring that your front-end details are in order. The window to appeal a denied claim is getting smaller. This class will explain how to expedite claims and appeals and get paid.
Class Highlights:
- Explanation and analysis of federal and commercial carrier guidelines
- Overview of insurance plans and payment models
- How to ensure that chart documentation supports claims submitted
- Checklist of necessary patient information
- Insurance verification and preauthorization
- Working with pre-certification and authorizations for continued treatment
- Proper use of the Advance Beneficiary Notice
- Working with Medicare as a secondary payer
- How to appeal inadequate reimbursements
- Patient education and grievance issues
- Procedure for capturing lost charges
- Billing for pre-existing conditions
- Coordination of benefits for covered/non-covered services
- Working with general liability claims
- Address common claims processing errors
- Medicare’s Correct Coding Policy as it pertains to billing
- Tips to avoid duplicate charge rejects
- How to handle refunds for overpayments
- Recovery Audit contractor claim review process
- Know your rights and responsibilities during an audit
See the full course description here.
Target Audience
This training is designed for claims processors with limited experience, as well as physicians, consultants and clinical staff seeking a better understanding of carrier reimbursement.
What to Bring
Registration includes a digital course manual
Full Schedule
Program times are Central unless otherwise noted.
| Session | Date | Time | Instructor | |
| 1 | June 18, 2025 | 11:00 am-2:00 pm | Jan Hailey | |
| Fee: $239.00 | Register | |||
Can't attend a live session? Register anyway and you'll receive a link to the recording by the next business day. | ||||
CEUs:
| PMI | 3 |
About the Presenter
Jan Hailey MHL, CMC, CMCO, CMIS, CMOM, CMCA E/M
Jan Hailey has more than 30 years of experience in healthcare. She is proficient in administration, coding, and billing roles, and teaches medical office professionals around the country how to excel in their careers. Jan has also been instrumental in the development of PMI's Workforce Initiatives program.
Jan's affinity for teaching has helped countless healthcare providers and medical office professionals over the years. During her expansive career, she has served as Director of Quality for Saint Joseph Physician Network located in Mishawaka, IN, and Director of Care Management with Select Health Network, an entity of Saint Joseph Health System. As Care Management Director, Jan led the physician network and comprehensive interdisciplinary team across the health system working closely with providers, management, staff, community, and payers to develop strategies for process improvement, gap closures, and patient experience. She developed a documentation improvement program and a Hierarchical Condition Category (HCC) coding education program to predict future healthcare utilization by accurately reporting patient complexity.
Prior to joining Saint Joseph, Jan was the Director of Quality, Coding, and Compliance for one of the largest health systems in Northern Indiana. She has a Master of Health Leadership and four professional certifications in office management, coding, insurance processing, and compliance. She is a member of WPS Government Health Administrators (Medicare) Provider Outreach and Advisory Group.