AR Analyst(Ambulatory)

Accounts Receivable Analyst

Mandate 3 +yrs experience in AR Ambulatory services.

• Perform pre-call analysis and check the status by calling the payer or using IVR or web portal services.
• Maintain adequate documentation on the client software to send the necessary documentation to insurance companies and maintain a clear audit trail for future reference.
• Record after-call actions and perform post-call analysis for the claim follow-up.
• Provide accurate information to the insurance company, research available documentation including authorization, physician notes, medical documentation on PM system, interpret explanation of benefits received, etc. prior to making the call.
• Perform analysis of accounts receivable data and understand the reasons for underpayment, days in A/R, top denial reasons, use appropriate codes to be used in documentation of the reasons for denials/underpayments.
• Comply with all reimbursement and billing procedures for regulatory, third party, and insurance compliance norms.
• Responsible for meeting daily/weekly productivity and quality reasonable work expectations.

Responsibilities

• Claim processing and submission.
• Submit the claim to insurance companies to receive payment for services rendered by a healthcare provider.
• Taking denial status from various insurance carriers
• Checking eligibility and verification of policy
• Analysis of the data
• Converting denials into payments
• Follow Health Insurance Portability and Accountability Act (HIPAA)
• Account follow up on fresh claims, denials, and appeals.
• Checking the claim status as per their suspension and denials
• Achieving weekly/monthly production and audit target

Qualifications/Requirements

• High School (HSC) or graduate or equivalent with strong analytical skills.
• 1-3 Years of experience in accounts receivable follow-up/denial management for US healthcare.
• Good written and verbal communication skills.
• Knowledge of medical terminology, ICD10, CPT, and HCPC coding.
• Basic working knowledge of computers.
• Willingness to work continuously in night shifts.

Preferred

• Familiar with healthcare patient billing systems (Practice management) like NextGen, eCW, Carecloud, Docutap.
• Familiar with clearinghouse like Waystar, Realmed Availity, change healthcare, via track.
• Proficiency with MS Excel, MS Word, google spreadsheet, etc.

Other Skills and Abilities

• Ability to work independently with minimal supervision.
• Good analytical skills, assertive in resolving unpaid claims.
• Ability to multi-task and accurately process high volumes of work.
• Strong organizational and time management skills

Individual Contributor