This function is very critical to optimize client revenue recovery and increase the cash inflow. It is a process where unpaid / denied claims are re-worked and corrected to receive the entitled reimbursement from the Insurance companies. It takes articulate professionals to communicate with insurance companies to settle disputed claims.
Roles and Responsibilities:
- Perform pre-call analysis and check status by calling the payer or using IVR or web portal services
- Provide accurate claim information to payer rep, research available documentation including authorization, nursing notes, medical records on client’s systems, interpret explanation of advantages received etc. prior to making calls
- Initiate calls requesting status of claims in queue by following the international norms / rules for confidentiality and HIPAA compliance
- To prioritize the pending / overdue tasks for calling / working from the aging basket
- Contact insurance companies for further explanation of denials and underpayments
- Maintain adequate documentation on the client software to send necessary documentation to insurance companies and maintain a clear audit trail for future reference
- Routing denials to the correct department and take appropriate action on claims to guarantee resolution
- Perform analysis of accounts receivable data and understand the reasons for underpayment, days in AR, top denial reasons, use appropriate codes to be used in documentation of the reasons for denials / underpayments
Technical Expertise:
- Core Expertise on AR, Denial Management, Eligibility verification, Prior-Authorization, Claim Submissions, Rejections, Correspondence
- Expertise in PMS (ECW, NextGen, Advance MD, All Scripts) will be preferred – Ascent will provide training on the client's medical billing software as part of the training
- Capable of task execution based on work instructions
- Good Communication Skills – Verbal and written
- Proficiency in Excel – MS Office
- Adapting to new situation & challenges whenever required