Process Specialist

3 weeks ago

Chennai, India Thryve Digital Full time

The Senior AR Collections Agent is responsible for the timely and effective collection of outstanding accounts receivable (AR) for healthcare services. This role involves in-depth knowledge of medical billing, coding, payer regulations, and collection techniques. The Senior Agent handles complex cases, provides guidance to junior team members, and plays a key role in improving the overall collection process.

Key Responsibilities:

Collections Activities:

Manage and resolve complex and high-dollar AR claims.

Investigate and analyze aged AR to determine appropriate collection strategies.

Contact insurance companies, patients, and other responsible parties to pursue payment.

Document all collection activities accurately and thoroughly in the billing system.

Review and interpret Explanation of Benefits (EOBs) to identify discrepancies and denials.

Appeal denied claims and follow up on pending appeals.

Negotiate payment plans with patients according to established guidelines.

Identify and escalate problematic accounts to management for further action.

Understanding of HIPAA regulations and ensure compliance in all activities.

Stay current on changes in payer regulations, coding guidelines, and billing requirements.

Problem Solving and Analysis:

Identify trends in denials and payment issues and propose solutions to prevent recurrence.

Work with other departments (e.g., billing, coding, registration) to resolve billing errors and process issues.

Research and resolve complex billing inquiries from patients and insurance companies.

Mentorship and Training:

Serve as a mentor and resource for junior AR Collections Agents.

Assist in training new team members on collection procedures and systems.

Provide guidance on handling difficult or complex accounts.

Reporting and Process Improvement:

Prepare regular reports on AR status, collection rates, and key performance indicators (KPIs).

Identify opportunities to improve collection processes and increase efficiency.

Participate in team meetings and contribute to process improvement initiatives.

System Proficiency:

Utilize billing software and other relevant systems to manage accounts and track collection activities (e.g., EPIC, Cerner, etc.).

Maintain accurate and up-to-date information in the billing system.

Qualifications, Experience & Skills:

Undergraduate degree or equivalent required; Associate's or Bachelor's degree in a related field preferred.

Minimum of 5-7 years of experience in Phycian Billing/Hospital billing RCM AR collections.

Proven track record of successfully collecting outstanding AR.

Experience working with various insurance payers (e.g., Medicare, Medicaid, Commercial).

In-depth knowledge of revenue cycle management

Strong understanding of payer regulations and reimbursement processes.

Excellent communication and interpersonal skills.

Strong analytical and problem-solving abilities.

Proficiency in using billing software and Microsoft Office Suite.

Ability to work independently and as part of a team.

Excellent organizational and time-management skills.

Ability to handle a high volume of accounts and meet deadlines.

Preferred Qualifications:

Experience with EPIC preferred but not mandatory

Both Hospital and Professional billing experience preferred

Flexible to work from Office all 5 days in the week in US shift

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