Senior Executive

Key Responsibilities:

· Investigate claim rejections or denials, identify root causes, and take corrective actions to resolve issues and resubmit claims.

· Track outstanding accounts and work to reduce aging AR through timely follow-ups

· Should met the standard quality of above 98 % and quantity of 100%

· Report to team leaders about inventories.

· Ensure adherence to healthcare regulations, payer policies, and internal guidelines to maintain the accuracy and integrity of the billing process.

Daily Routine:

· Planning the day & Prioritizing the tasks

· Active participation in Daily Huddles

· Handling tickets

· Need to take action for Sec Rejections/Denials

· AR Activity (Follow-up, Attention Required, No Resp, etc,.)

· Need to send EOD status to Team leader

· Need to initiate the call to the payers and obtain the required information.

Weekly Routine:

· Preparing AR clarifications

· Secondary claims review & Submission

· Weekly meeting with Team leader/Manager

· Weekly denials trend analysis

Monthly Routine:

· Updating company scorecards

· Small Balance Adjustment

· AR Clarification/UC claims list preparation

· Redzone clients status update.

Skills and Competencies:

· Basic technical skills in computer (Word & Excel)

· Good written and verbal communication skills

· Ability to explain billing issues to the supervisors clearly and professionally.

· Competency in identifying issues with claim payments or denials and finding solutions.

· Ability to track outstanding receivables and prioritize collections based on aging.

Qualifications:

· Any Degree and above.

· 2+ years’ experience End-to-end process in RCM.

· Knowledge in our Major PMS (IMS/eCW

· Typing Skills (30 WPM with >95% Accuracy)

Key Performance Indicators (KPIs):

· Quality % - >=98%

· Quantity % (Productivity) - 100%