SME

Experience with in hospital billing (UB -04) with IPA & Commercial claims processing

At least 3 years of experience in hospital billing & Proficient in Payment systems

Analyze and address complex denials, rejections, and underpayments while serving as a process expert in AR workflows, payer guidelines, and billing systems.  

Assist the team with escalated issues and client inquiries, providing feedback and coaching to enhance team performance.  

Support the training of new employees and promote ongoing knowledge sharing within the team.  

Collaborate with internal departments, such QA, Training team to resolve issues and prepare daily and weekly performance reports.  

Requirements

Experience with hospital billing (UB -04) with IPA & Commercial claims processing

Strong knowledge in inpatient (IP) and outpatient (OP) billing workflows, denial management and appeals process

At least 2 years of experience in medical billing, specializing in Payment systems and contract sheet validation (IPPS & OPPS, APC Fees Schedule, DRG & APRDRG)

In -depth knowledge of Hospital Billing Accounts Receivable processes, including Denial Management and Appeals.  

Proficient in analyzing EOB/ERA and understanding payer guidelines for Medicare, Medicaid, and Commercial plans.  

Familiar with various payment methodologies such as IPPS, OPPS, DRG/APR -DRG, and APC Fee Schedule.  

Experienced in managing high -value and aged accounts receivable with strong analytical and problem -solving abilities.  

Effective communicator with the capability to mentor and support team members.  

Interested candidates can send their updated resumes to: twinkleamaldia@shai.health

(Mail subject line: "Applying for Experienced Hospital Billing Executive” for any quires call to this number 9500202989).