Claims Recovery Specialist
4 days ago
The primary responsibility of this role is to manage outstanding claims, ensuring accurate payments for healthcare services.
This individual will serve as the crucial link between the finance team, insurance companies, and patients to resolve outstanding balances. Effective communication and collaboration skills are essential in this position.
Responsibility Areas:
- Manage day-to-day activities related to denials processing and claims follow-up.
- Handle US Healthcare providers, physicians, and accounts receivable.
- Work closely with the team leader to ensure deliverables adhere to quality standards.
- Responsible for working on denials, rejections, LOAs to accounts, making required corrections to claims.
- Calling the insurance carrier & document actions taken in claims billing summary notes.
- Review emails for any updates.
- Identify issues and escalate them to the immediate supervisor.
- Update production logs.
Desired Profile:
- Sound knowledge in Healthcare concepts (Physician Billing).
- Minimum 2 years of AR calling experience in US Healthcare.
- Excellent knowledge on RCM, Medicare, Medicaid, Hospice, HMO, PPO, POS, EPO, MCO plans, modifiers, CPT codes, office code visits, drug codes, appeals, denial management, CMS-1500 form, clearing house, etc.
- Understand client requirements and specifications of the project.
- Should be proficient in calling the insurance companies.
- Ensure targeted collections are met on a daily/monthly basis.
- Meet productivity targets of clients within stipulated time.
- Ensure accurate and timely follow-up on pending claims where necessary.
- Prepare and maintain status reports.
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