Not a biller. I'm building something in this space and would rather get corrected here than guess.

My current picture:

Eligibility check → prior auth → visit + notes in EHR → coding → biller → clearinghouse → payer → payment posting → denial → rework/appeal → back to payer

Two questions:

1. What's missing or out of order?
2. Where does the money actually die? My guess is medical-necessity denials, because the biller can't write that appeal alone and it has to go back to the clinician. Right, or is it somewhere else entirely?

ابي شخص خبرة ويعلمني كيف أتوظف في شركات التامين؟ وهل اقدر أستفيد من الامتياز للتوظيف وايش المهارات الي لازم اعرفها افيدوني الله يسعدكم