Key Responsibilities:
Process:
● 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 benefits 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
● Basic Knowledge of MS Office would be preferred.
● Typing Speed
● Eye for Detail
Behavioral Competencies:
● Team Work ● Communication
● Customer Service Orientation ● Accountability
● Analytical Thinking
* Please note: The competencies highlighted above under the functional and behavioral competencies are the MUST HAVE competencies in the role and need to be mandatorily measured during the assessments OR hiring process
IKS Health Navi Mumbai, Maharashtra, IND Office
Raheja Mindspace, Airoli, Thane, Navi Mumbai, Maharashtra, India, 400708
