Which department primarily handles claims denials and resolution processes?

The Billing and Collections department is primarily responsible for managing claims denials and the resolution processes. This department specializes in the financial aspects of healthcare services, which includes submitting claims to insurance companies and following up on any denials. Their core function involves ensuring that all services provided are accurately billed and reimbursed, which means they must work closely with insurance representatives to understand the reasons behind denials and to rectify issues that may arise.

This department also engages in appeals processes when a claim is denied, investigating the reasons for denials and providing additional documentation or clarification to address the insurance company’s concerns. Their expertise in coding, billing regulations, and compliance is crucial for navigating the complexities of insurance claims and ensuring that the healthcare provider receives appropriate compensation for services rendered.

In contrast, other departments such as Human Resources, Patient Services, and Medical Records do not typically engage in the specific processes related to claims denials. Human Resources focuses on employee management and organizational support, Patient Services is centered around patient interaction and care, and Medical Records manages patient information and documentation, lacking the direct involvement in the financial resolution process. Thus, the Billing and Collections department plays the key role in addressing claims denials and resolving related issues.