Job Description Summary-
Responsible for the overall recovery and management of accounts receivable as it relates to maximizing accounts receivable collections for RCMS clients. The position involves detailed research and follow-up on medical insurance claims and the careful preparation of appeals and responses to efficiently interact with insurance carriers and resolve the claim. Supports the RCMS BU's overall Operations and Client Services by efficiently and effectively driving the accounts receivable process and achieving KPI results.

No budget responsibilities, but must meet established RCM KPI's.

Work Location - Pune (Work from office)
Shift Timing - 7.30 PM to 4.30 AM
Job Description-
Strong customer service skills for client satisfaction and client AR health
answering client, patient and carrier calls; prompt return and follow up to all interactions; prompt response to requests for information
Timely management of unpaid claims as assigned, through the use of the client's office management/administrator;
aging reports; correspondence; Clearinghouse and PM rejections; SharePoint reference/maintenance
Effectively handle complex payer denials; responsible to ensure that secondary claims are processed and paid
Monitoring and reconciliation of claims to include:
Held vouchers
Unbilled vouchers
Denial trends
Patient balance report
Credits and refunds
Manage and track information requests to client.
Answer and resolve all incoming calls and requests in a timely manner.
Complies with and enforces policies and procedures
Achieves goals set forth by RCM management regarding error-free work, transactions, processes, productivity and compliance requirements. Specific goals include 1,400 accounts worked per month
May act as partner for new hires to assist them in learning
Other duties as assigned

Knowledge, Skills And Abilities

Extensive knowledge with email, search engines, Internet
ability to effectively use payer website and Laserfiche; basic competence in use of Microsoft products
Preferred experience with MS Access and PowerPoint, Crystal reports
Experience with various billing systems, such as NextGen, Pro, Allscripts, Epic and others
Knowledge of CPT, ICD10 and modifiers.
Experience in specialties such as Psychiatry, Internal Medicine, Orthopedics, General Surgery
Familiar with HMO and IPAs, Medicare Fee for Service Plans and Commercial Payers

Working Arrangements

Standard work week or as defined by assignment requirements
Primarily works in standard office environment or remotely
May require after-hours, on-call support and/or holidays
On-call and after hours work during peak times including end of month/quarter/year; during this time PTO is limited to meet business needs

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
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/

Veradigm is proud to be an equal opportunity workplace dedicated to pursuing and hiring a diverse and inclusive workforce.

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RCM AR Specialist