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%
