Key Responsibilities for AR:
- 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 the 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, and 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 the RCM end-to-end cycle and proficiency in AR fundamentals and denial management.
- Basic knowledge of computers and MS Office.
