Senior Executive-Back Office-Claims Medical Bill Review

2 days ago

India EXL Full time ₹ 4,50,000 - ₹ 9,00,000 per year
Description
  • 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
  • Resolve/Fix the edits and rejections in the PMS and clearing house
  • Track rejections and edit trends and fix the reoccurrence
Responsibilities

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 (i.e. due to new scenarios/trends/patterns in billing)  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

Qualifications: 

  • Graduation in any stream
  • Experience: BPO Experience: 2-5 years
  • US Healthcare AR with Front end rejections experience preferred  
  • Communication Skill: Excellent written (documentation) and oral communication skill

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