● Responsible for achieving the defined TAT on deliverables with the agreed Quality benchmark score. ● Responsible for analyzing an account and taking the correct action.
● Ensuring that every action to be taken should be resolution oriented whilst working on the specific task/case assigned.
● Task claims to appropriate teams where a specific department within IKS, or client's assistance is required to resolve them.
Billing:
● Responsible for ensuring accurate billing to the payer for a specific claim.
● Addressing the clearing house and front end rejections in a timely manner within a TAT of 24 hour period
AR:
● Follow up with the payors on open claims beyond a reasonable time period to identify it's accurate action.
● Analyze denials from insurances, verify its authenticity, understand causes and resolve them.
● Ensure claims are followed up as per assigned ticklers within the stated time period.
● Manage ageing on the assigned work file.
PP:
● Responsible for posting the electronic payments once received from the payer onto the client's system
● Responsible for posting the manual payments once received from the payer onto the client's system
● Balancing the Batches / Reconciliation
● Ensuring that correct balance is flipped to the patient where applicable.
● Ensuring that appropriate adjustments are executed based on payor policies, client guidelines, and adhoc approvals.
EV/BV:
● Responsible for reaching out to the payor to check on the insurance eligibility and the perks of the patient
● Addressing the claims to insurance or Self Pay (Patient Attention) based on the eligibility identified
Qualifications: Graduate from any discipline is a must
Role Prerequisites:
● Minimum 1 year and above experience in AR, PP, Billing and EV/BV is a must.
Functional Competencies:
● Knowledge of the US healthcare RCM industry would be preferred
● Basic Knowledge of working on computers would be preferred