Sr. Executive/ Executive RCM

About Us:

Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals. 

We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success.  

ESSENTIAL DUTIES AND RESPONSIBILITIES: 
Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member’s performance objectives as outlined by the Team Member’s immediate Leadership Team Member.

Roles and Responsibilities:

• Perform pre-call analysis and check status by calling the payer or using IVR or web portal services.
• Maintain adequate documentation on the client software to send necessary documentation to insurance companies and maintain a clear audit trail for future reference.
• Record after-call actions and perform post call analysis for the claim follow-up.
• Assess and resolve enquiries, requests and complaints through calling to ensure that customer enquiries are resolved at first point of contact.
• Provide accurate product/ service information to customer, research available documentation including authorization, nursing notes, medical documentation on client's systems, interpret explanation of benefits received etc prior to making the call.
• Perform analysis of accounts receivable data and understand the reasons for underpayment, days in A/R, top denial reasons, use appropriate codes to be used in documentation of the reasons for denials / underpayments.
• Prepare, review, and transmit claims using AR software, including electronic and paper claim processing.
• Review patient bills for accuracy and completeness and obtain any missing information.

Required Expertise & Qualification:

• 12th Pass/Graduate in any discipline
• 8 months – 5 years of Years of experience in accounts receivable follow-up / denial management for US healthcare customers.
• Proficient computer skills. Excellent communication skills, both verbal and written.
• Strong people skills & Outstanding organizational skills.
• Ability to maintain the confidentiality of information.
• Willingness to work continuously in night shifts

PHYSICAL DEMANDS:
Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines.
A job description is only intended as a guideline and is only part of the Team Member’s function. The company has reviewed this job description to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.