RCM Senior Claims Processor

Veradigm

Welcome to Veradigm! Our Mission is to be the most trusted provider of innovative solutions that empower all stakeholders across the healthcare continuum to deliver world-class outcomes. Our Vision is a Connected Community of Health that spans continents and borders. With the largest community of clients in healthcare, Veradigm is able to deliver an integrated platform of clinical, financial, connectivity and information solutions to facilitate enhanced collaboration and exchange of critical patient information.

We are an Equal Opportunity Employer. No job applicant or employee shall receive less favorable treatment or be disadvantaged because of their gender, marital or family status, color, race, ethnic origin, religion, disability or age; nor be subject to less favorable treatment or be disadvantaged on any other basis prohibited by applicable law.

For more information, please explore Veradigm.com.

What will your job look like:

This position reports to the Claims Manager and is responsible for the daily preparation of electronic claims processing, manual claim form processing, electronic transmission error corrections, patient statement processing, new client electronic claims enrollment authorization, client software training.

Main Duties:

• 
  
  
  
  • Daily transmission of electronic claims, either direct to the payer or via the clearinghouse.
  
  
  • Processing of HCFA 1500 claims forms.
  
  
  • Responsible for the setup of payor EDI numbers into PCN.
  
  
  • Enrollment of new clients to allow electronic data interchange/claims submission. The following is a list of current payers who require the client to submit an application and receive authorization prior to sending electronic claims. (Medicare, Medi-cal, Blue Cross, Blue Shield, Champus, Medicare RR and DMERC).
  
  
  • Transmission of patient statement files twice monthly on alternating Tuesdays.
  
  
  • Returned mail correction. Patient receives one call requesting an updated mailing address. If the patient does not respond than the balance is either adjusted off or transferred to a collection agency. Client specific small balance minimum policies reside within the policies and procedures folder on the shared drive.
  
  
  • Achieve goals set forth by supervisor regarding error-free work, transactions, processes and compliance requirements.
  
  
  • Other duties as assigned.
  
  
  
  

*** Essential functions may include:

• Performs initial review of database after wizard HL7 automation is complete


• Collaboration with RCMS team to trouble shoot system configuration issues


• Handles system dictionary table modifications and documentation


• Monitor BAM daily exceptions


• Address updates to registration based on USPS exceptions that do not update electronically


• Process paper claims


• supporting the onboard monitoring and tracking of progress


• Acts as a liaison between teams to ensure timely implementation on activation date


• Ensures SharePoint PF Onboarding tasks are updated daily


• Identified and reports risks to project  

• Must be highly organized and self-motivated


• Strong critical thinking skills


• Apply logic to technical claim problems


• Proficient in excel and Microsoft products


• Prior experience on Allscripts PM is a plus


• Strong communication skills


• Clearinghouse experience preferred

Academic Qualifications:

• 
  
  
  
  • High School Diploma or GED (Required)
  
  
  • 3+ Years of experience in relevant field 
  
  
  
  

An Ideal Candidate will have:

• 
  
  
  
  • Technical: Extensive knowledge on use of email, search engine, Internet; ability to effectively use payer websites and Laserfiche; knowledge and use of Microsoft Products: Outlook, Word, Excel. Preferred experience with various billing systems, such as NextGen, Pro and Allscripts.
  
  
  • Personal: Strong written, oral, and interpersonal communication skills; Ability to present ideas in business-friendly and user-friendly language; Highly self-motivated, self-directed, and attentive to detail; team-oriented, collaborative; ability to effectively prioritize and execute tasks in a high-pressure environment.
  
  
  • Communication: Ability to read, analyze and interpret complex documents. Ability to respond effectively to sensitive inquiries or complaints from employees and clients. Ability to speak clearly and to make effective and persuasive arguments and presentations.
  
  
  • Math & Reasoning: Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to use critical thinking skills to apply principles of logic and analytical thinking to practical problems.
  
  
  
  

Work Arrangements: Work from Pune Office all 5 days.

Shift Timing: 7:30 PM IST to 4:30 AM IST (US Shift)

Benefits

Veradigm believes in empowering our associates with the tools and flexibility to bring the best version of themselves to work. Through our generous benefits package with an emphasis on work/life balance, we give our employees the opportunity to allow their careers to flourish. 

• Quarterly Company-Wide Recharge Days


• Peer-based incentive “Cheer” awards


• “All in to Win” bonus Program


• Tuition Reimbursement Program

To know more about the benefits and culture at Veradigm, please visit the links mentioned below: -

https://veradigm.com/about-veradigm/careers/benefits/

https://veradigm.com/about-veradigm/careers/culture/