Job purpose
Experienced in end-to-end follow-up and resolution of outstanding patient and insurance balances for U.S. healthcare clients. Skilled in delivering accurate, compliant, and timely cash collection while upholding core principles: customer-first, straightforward communication, respect, humility, and continuous learning.
Key Responsibilities:
- Cash Collection & Follow-Up: Daily follow-up on unpaid/underpaid claims via calls or portals; resubmit corrected claims and appeals within payer time limits; track actions in billing platforms.
- Account Integrity: Audit 50–75 claims per shift for coding, units, and payer rules; reconcile credit balances.
- Denial Management: Analyze EOB/ERA codes, assign root-cause categories, and record preventative notes for training and proactive process improvement; reduce denial rate by 2 ppt within six months.
- Eligibility & Authorization: Verify coverage and prior-authorization status before resubmission; log variances for provider feedback.
- Patient Experience: Resolve patient balance queries within 2 business days via phone/email, maintaining 95% CSAT.
- Compliance & Reporting: Safeguard PHI per HIPAA, SOC 2, and organizational policies; update daily A/R aging dashboard; escalate any >45-day spike to the manager and complete daily checklists before close of shift.
Qualifications & Skills:
- Graduate degree or diploma in commerce, healthcare administration, or equivalent.
- CPC or CPB certification preferred.
- Proficient in practice management or RCM platforms (e.g., Athena One, Kareo, eClinicalWorks).
- Advanced Excel skills (pivot tables & lookups); basic Power BI or similar dashboard exposure.
- Comfortable with productivity trackers and generative-AI assistance tools.
- Proactive, takes initiative without hand-holding.
- Team player; always willing to help colleagues.
- High attention to detail; targets zero posting errors.
- Persistent yet respectful communicator with parties.
- Clear English—spoken and written.
- Embraces organizational principles in daily behavior.
Work Environment:
- Work from Office: Operates from a dedicated office environment, ensuring a structured and collaborative setting.
- Night Shift: Committed to working night shifts to align with U.S. healthcare client timelines, demonstrating flexibility and dedication.
