Reviews and resolves outstanding and denied healthcare claims, coordinates with insurers, performs eligibility and demographic denial follow-up, and meets productivity and quality targets. Responsibilities include claims research, insurance verification, patient billing support, account updates, cash posting, contractual write-offs, timely escalation, and adherence to SLAs, calling guidelines, confidentiality requirements, and HIPAA compliance.
- Review and analyze the assigned outstanding receivables portfolio to identify unresolved claims.
- Manage and resolve outstanding and denied claims by coordinating effectively with insurance companies.
- Follow up promptly to obtain additional information required for claim resolution.
- Ensure all claims are resolved within established timelines and adhere to defined Service Level Agreements (SLAs).
- Perform website checks and handle non-callable denials to optimize receivables recovery.
Skills and abilities:
- Working on website related claims and action based on coding team responses.
- All non-callable denials, demographic and eligibility denials need to be worked
- Ensure Daily Productivity targets are met at the required quality level on the assigned inventory.
- Perform timely follow up on claims to avoid revenue loss, Prioritize the pending claims for calling from the aging bucket
- Review claims that have not been paid by insurance companies.
- Check insurance information provided by patient if it is insufficient or unclear.
Follow the guidelines and applicable rules while calling insurance companies for confidentiality and HIPAA compliance. - Escalate difficult collection situations to management in a timely manner, Handling patients billing queries and updating their account information.
- Post cash and write off the contractual adjustments accordingly while working on the accounts.
- Meeting daily/weekly and monthly targets set for an individual.
Qualifications: Graduation in any stream
Experience: BPO Experience: 3-6 years
US Healthcare AR experience
Communication Skill: Excellent written (documentation) and oral communication skill
About Us EXL (NASDAQ: EXLS) is a leading data analytics and digital operations and solutions company. We partner with clients using a data and AI-led approach to reinvent business models, drive better business outcomes and unlock growth with speed. EXL harnesses the power of data, analytics, AI, and deep industry knowledge to transform operations for the world’s leading corporations in industries including insurance, healthcare, banking and financial services, media and retail, among others. EXL was founded in 1999 with the core values of innovation, collaboration, excellence, integrity and respect. We are headquartered in New York and have more than 54,000 employees spanning six continents. For more information, visit www.exlservice.com.
EXL Chennai, Tamil Nadu, IND Office
Chennai, India
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