RCM Associate

Pre Auth:

● Obtains prior-authorizations and referrals from insurance companies prior to procedures or Surgeries utilizing online websites or via telephone.

● Monitors and updates current Orders and Tasks to provide up-to-date and accurate information.

● Provides insurance companies with clinical information necessary to secure prior-authorization or referral.

● Good understanding of the medical terminology and progress notes.

● Obtains and/or reviews patient insurance information and eligibility verification to obtain prior-authorizations for injections, DME, Procedures, and surgeries.

● Request retro-authorizations when needed.

Shift Timings: 5:30 PM to 2:30 AM / 6:30 PM to 3:30 AM

EVBV:

● Responsible for reaching out to the payer to check on the insurance eligibility and the

benefits of the patient.

● Addressing the claims to insurance or Self Pay (Patient Attention) based on the

eligibility identified.

● Responsible for achieving the defined TAT on deliverables with the agreed Quality

benchmark score.

● Responsible for analysing an account and taking the correct action.

● Ensuring that every action to be taken should be resolution oriented whilst working

on the specific task/case assigned.

● Task claims to appropriate teams where a specific department within IKS or client's

assistance is required to resolve them.

Shift Timings: 5:30 PM to 2:30 AM / 6:30 PM to 3:30 AM