Role & responsibilities
Insurance Follow-ups:
Contact insurance companies (via calls or portals) to check the status of pending medical claims.
Claim Status Verification:
Review and verify claim details, payment status, denials, and rejections.
Denial Management:
Analyze reasons for claim denials and take necessary actions such as re-submission or escalation.
Payment Posting Support:
Assist in identifying underpayments or overpayments and report discrepancies.
Accounts Receivable Management:
Work on assigned AR queues to reduce outstanding balances and improve cash flow.
Documentation:
Accurately document call details, claim updates, and actions taken in the system.
Appeals & Reprocessing:
Initiate appeals for denied claims and follow up until resolution.
Timely Follow-ups:
Ensure regular follow-ups on unpaid or partially paid claims within TAT (Turnaround Time).
Compliance:
Maintain compliance with HIPAA guidelines and company policies.
Coordination:
Work closely with billing, coding, and internal teams to resolve claim issues.
Productivity & Quality Targets:
Meet daily/weekly/monthly targets in terms of calls, collections, and quality standards.
Valuable communication and negotiation skills
Knowledge of US healthcare/medical billing process
Understanding of insurance policies and denial codes
Basic computer skills (Excel, billing software)
Attention to detail and problem-solving ability
Preferred candidate profile
Educational Qualification:
Any graduate (Commerce / Life Sciences / Pharmacy background is an advantage)
Communication Skills:
Excellent verbal communication skills with neutral accent and good listening ability
Process Knowledge:
Robust understanding of medical billing, insurance claims, denial management, and AR follow-ups
Technical Skills:
Basic knowledge of MS Excel and medical billing software/tools
Analytical Skills:
Ability to analyze claim denials and take appropriate action for resolution
Work Flexibility:
Willingness to work in night shifts (US timings)
Target-Oriented:
Ability to meet productivity, quality, and collection targets
Team Player:
Valuable interpersonal skills and ability to coordinate with internal teams
Adaptability:
Quick learner with the ability to handle multiple tasks and work under pressure