IP Resubmission Specialist

2 weeks ago

Chennai, Tamil Nadu, India ACCUMED Practice Management Medical Billers Full time ₹ 9,00,000 - ₹ 12,00,000 per year

Job Family Summary:

Business Management department is responsible for managing the client relations, insurance relations, reconciliation, and collection for ACCUMED clients. This department takes accountability of maintaining relationship with payers, regulators in the region. Responsible for client retention through stakeholder management internally and externally.

Role Summary:

The main responsibility of the role is to process claims with proper quality and to ensure the claims are paid in timely manner. The requires attention to details as the claims has already been rejected previously and is now in the reconciliation process for settlement.

Primary Responsibilities

Evaluates and ensures that all the medical & technical claims denied or underpaid inappropriately by payers are identified, appealed and reversed as per the set deadlines.

Maintains production goals and quality standards set by the Team Leader. Team leaders will be conducting regular audits against the standard expected level of quality and quantity.

Ensures all claims are in compliance with coding & insurance guideline

Maintains and achieves the target deadlines

Provides daily feedback for rejection trends, and to avoid it in the future in order to optimize clients revenue, conveys such feedback to team leaders for future occurrence

Raises queries to the team leader to get required documents

Job Requirements:

Complete Knowledge of both HAAD & DHA Guidelines.

Coding background IP/ OP

Paramedical knowledge

Claim processing

Key Performance Indicators (KPI's):

Process claims as per set targets

Meet the targeted productivity and report back to the management

Provide daily feedback to the line manager on the rejection trends

Raise queries to the line manager

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