Accounts Receivable Executive
- Way4travels Adventure
- 1 to 5 Yrs
- Noida, Gurugram
- 4 years ago
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Job Description
Job description
The Denial Management Specialist identifies, collects, and determines root causes of underpaid claims by auditing payor performance and analyzing actual payments of payors to ensure contract compliance which is operationally critical and sensitive in nature. The Revenue Recovery Analyst/Denial Specialist will support the RCM collection team with training and escalated claim follow up. She/he performs payment variance deep dive and review activities related to the incorrect processing of claims across company. This position will focus on the resubmission, reprocessing and correcting of denied or rejected/exhausted insurance claims (2nd Level) as well as all high-volume facilities, top payors, and high-level complex claim issues.
Essential Functions Essential functions encompass the required tasks, duties and responsibilities performed as part of the job and the reason the job exists.
- Utilize independent judgment and exercise discretion to ensure timely review and auditing of underpaid claims.
- Analyze, collect underpayments, and resolve claims with discrepancies from expected payment to ensure payors are in payment compliance with their contracted terms.
- Compile billing, and payor documentation to create training documents.
- Initiate and follow through with all relevant parties to ensure corrective actions are implemented (i.e., pursue underpayments, adjust expected reimbursement, address billing issues, negotiate settlements, etc.) according to payor specific processes.
- Respond to payment discrepancies by creating appeal letters and articulating contract provisions to representatives from third party payors. Work directly with payor to recover payments.
- Quantify payor trends and maintain productivity and accuracy standards in highly challenging environment. Prepare 2nd level appeals, recoveries, and potential settlements
- Ability to extrapolate complex claims data and payer information to accurately report trends and payor behaviors.
- Develops dashboards and reports on key performance indicators, metrics, data points, and formulas to support management objectives.
- Extract, load and reconcile large data sets from multiple system platforms and sources.
- Review data to determine operational impacts, trends, and areas for improvement.
- Follow up on claim submissions to determine batch acceptance, rejection, or denial in a timely manner.
- Research, correct, resolve, resubmit and appeal denied claims/services. Corresponds with insurance companies to resolve the issue; submits appeals per payor requirements.
- Communicate with RCM leadership about payor updates, changes, and requirements.
- Sort and file paperwork from health plans, patient charts, and payment correspondence.
Support the team in their efforts to provide payors with information or documentation necessary for payment of claims and/or any other account follow up required to recover payment within a required timeframe.
Qualifications
- Graduation is Must
- 4 Years and above experience in healthcare accounts receivable/denials management is required.
- Strong knowledge of medical insurance (HMO, PPO, Medicare, Medicaid, Private Payers).
Interested candidate can contact:
Email on hidden_email
Employement Category:
Employement Type: Full timeIndustry: KPO / Analytics Role Category: Customer Service (International) Functional Area: Not ApplicableRole/Responsibilies: Accounts Receivable ExecutiveContact Details:
Company: Way4travels AdventureLocation(s): Noida, Gurugram
Keyskills: medical billing denial management denial handling denials ar calling
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