Revenue Cycle Representative_AR

6 months ago

Mumbai, India IKS Health Full time

Key Responsibilities:

Process : 

● Responsible for achieving the defined TAT on deliverables with the agreed Quality benchmark score. ● Responsible for analyzing 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.

Billing:

● Responsible for ensuring accurate billing to the payer for a specific claim. 

● Addressing the clearing house and front end rejections in a timely manner within a TAT of hour period

AR: 

● Follow up with the payors on open claims beyond a reasonable time period to identify it's accurate action. 

● Analyze denials from insurances, verify its authenticity, understand causes and resolve them. 

● Ensure claims are followed up as per assigned ticklers within the stated time period. 

● Manage ageing on the assigned work file.

PP: 

● Responsible for posting the electronic payments once received from the payer onto the client's system 

● Responsible for posting the manual payments once received from the payer onto the client's system

● Balancing the Batches / Reconciliation 

● Ensuring that correct balance is flipped to the patient where applicable. 

● Ensuring that appropriate adjustments are executed based on payor policies, client guidelines, and adhoc approvals.

EV/BV: 

● Responsible for reaching out to the payor 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

Qualifications : Graduate from any discipline is a must

Role Prerequisites:

 ● Minimum year and above experience in AR, PP, Billing and EV/BV is a must.

Functional Competencies: 

● Knowledge of the US healthcare RCM industry would be preferred 

● Basic Knowledge of working on computers would be preferred 

● Basic Knowledge of MS Office would be preferred. 

● Typing Speed

● Eye for Detail

Behavioral Competencies: 

● Team Work ● Communication 

● Customer Service Orientation ● Accountability 

● Analytical Thinking

Please note: The competencies highlighted above under the functional and behavioral competencies are the MUST HAVE competencies in the role and need to be mandatorily measured during the assessments OR hiring process

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