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Full-Time

BILLING SPECIALIST

Responsibilities:

Perform claim processing activities like charge extraction, claim creation, and claim transmission.
Understand the reason for scrubber, clearing-house, and payer rejections.
Work on the resolution of the rejection by performing follow-up with the client, clearing-house, or payer using the most optimal method i.e., calling, IVR, web, or email.
Timely and accurate release of the patient statement, resolve unbilled, and hold inventory.
Take appropriate action to ensure clean claim submission.
Documentation of all the actions on the practice management system and workflow management system, maintain an audit trail.
Ensure adherence to Standard Operating Procedures and compliance.
Highlight any global trend/pattern and escalate any issue with the leadership team.
Meet the productivity and quality target on a daily/monthly basis.
Upskill by learning new/additional skills and enhancing competencies. Active participation in all process/client-specific training and refresher training.

Requirements:

Undergraduate / Graduate in any stream with 2 to 4 years of experience in US Healthcare RCM for Medical Billing
Good communication both verbal and written is preferred.
Good analytical skills, attention to detail, and resolution oriented.
Should know RCM end-to-end cycle and proficiency in Medical Billing.
Basic knowledge of computer and MS Office.

Full-Time

Responsibilities:

Monitor and work from the workflow queue and maintain client-specific TAT.
Perform Eligibility Verification i.e. verify whether the patient has valid coverage for the specified Date of Service or a time period using the most optimal method i.e., calling, IVR, web, or portal.
Use the most optimal method (calling or web/portal) to perform Benefit Verification i.e. verify whether the patient has benefits coverage based on the specific specialty, a specific procedure, total Out-of-Pocket expenses to be borne by the patient including co-pay, deductible, and co-insurance, cost-share, and access/provider options according to the SOPs.
Verify Eligibility and Benefits for primary, secondary, and tertiary insurance.
Documentation of all the actions related to Eligibility and Benefits on the practice management system and workflow management system, maintain an audit trail.
Coordinate with the client in case there is any missing information/documentation to have the eligibility/benefits verification completed.
Update client about any delay in verification due to missing information or delay in receiving the requested information.
Ensure adherence to Standard Operating Procedures and compliance.
Highlight any global trend/pattern and escalate any issue with the leadership team.
Meet the productivity and quality target on a daily/monthly basis.
Upskill by learning new/additional skills and enhancing competencies. Active participation in all process/client-specific training and refresher training.

Requirements:

Undergraduate / Graduate in any stream with 2 to 4 years of experience in US Healthcare RCM.
Good communication both verbal and written is preferred.
Good analytical skills, attention to detail, and resolution oriented.
Should know RCM end-to-end cycle and proficiency in Eligibility and Benefits Verification.
Basic knowledge of computer and MS Office.

Full-Time

Responsibilities:

Post transactions into the practice management system based on the EOB / ERA / Correspondence received from the payer i.e., payments and denial batches.
Post transactions into the corresponding patient account at the line-item level/claim level and reconcile them.
Facilitate end-to-end Reconciliation from Bank Deposit to Batch Amount to the Posted Amount into the practice management system.
Work on the resolution of any discrepancies on EOB / ERA by performing follow-up with the client, clearing-house, or payer using the most optimal method i.e., calling, IVR, web, or email.
Take appropriate action to resolve any issue pending with the client and internal teams.
Audit patient statements for accuracy.
Resolve Credit Balance and follow process flow related to the processing of Refunds.
Documentation of all the actions on the practice management system and workflow management system, maintain an audit trail.
Ensure adherence to Standard Operating Procedures and compliance.
Highlight any global trend/pattern (under/overpayment) and escalate any issue with the leadership team.
Meet the productivity and quality target on a daily/monthly basis.
Upskill by learning new/additional skills and enhancing competencies. Active participation in all process/client-specific training and refresher training.

Requirements:

Undergraduate / Graduate in any stream with 2 to 4 years of experience in US Healthcare RCM for Medical Billing
Good communication both verbal and written is preferred.
Good analytical skills, attention to detail, and resolution oriented.
Should know RCM end-to-end cycle and proficiency in Medical Posting / Credit Balance process.
Basic knowledge of computer and MS Office.

Full-Time

Responsibilities:

Review account thoroughly including any prior comments on the account, EOBs / ERAs / Correspondence, and perform pre-resolution analysis.
Understand the reason for rejection, denials, or no status from the payer.
Work on the resolution of the claim by performing follow-up with payer using the most optimal method i.e., calling, IVR, web, or email.
Take appropriate action to move the account towards resolution, including rebilling the claim, sending claims for reprocessing, reconsideration, redetermination, appeal (portal/web, fax, mail), verifying eligibility and benefits, and managing management hand-off with the client, and internal teams.
Documentation of all the actions on the practice management system and workflow management system, maintain an audit trail.
Ensure adherence to Standard Operating Procedures and compliance.
Highlight any global trend/pattern and issue escalation with the leadership team.
Meet the productivity and quality target on a daily/monthly basis.
Upskill by learning new/additional skills and enhancing competencies. Active participation in all process/client-specific training and refresher training.

Requirements:

Undergraduate / Graduate in any stream with 2 to 4 years of experience in US Healthcare RCM for Account Receivable / Denial Management Resolution.
Fluent communication both verbal and written.
Good analytical skills, attention to detail, and resolution oriented.
Should have knowledge about RCM end-to-end cycle and proficiency in AR fundamentals and denial management.
Basic knowledge of computers and MS Office.