|Job Function||Collections – Insurance Follow up|
|General description||This function is very critical to optimise client revenue recovery and increase cash flow. 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.|
|Experience Range||1-6 years|
|Compensation||Upto 42K INR monthly, subject to years of experince and level of exposure|
|Job Timing||PST shift equivalent to 05:30 PM to 03:00 AM IST|
|Duties & Responsibilities||• Checking denials from EOBs, ERAs by calling the Insurance Companies|
• Getting the specification of denials from the insurance Company.
• Reprocessing the claim over the phone or reopening the claims on the online portals.
• Filing an appeal to the insurance companies with the required information • Checking status of the appeal filed and reprocessed claims through IVR, Calls and online payer’s portal • Refilling corrected claims with coding/demographic/authorization/referral corrections.
• Disputing with the insurance companies on incorrect denials.
• Working on FTH (Fix-The-Hole) to prevent future denials
• Tasking to the clients and other teams for required information
• Preparing Trending Analysis on the denials and escalating to Supervisors
• Finding updates from payers via call or online for billing related information and sharing with the concern team/department to prevent denials.
• Responsible for updating any internal databases, electronically storing and organizing patients’ records, billing details, and registration forms.
|Education||+2 or Graduate in any stream|
|Training/Work Experience||Collections – Insurance follow up and/or 1 year of industry experience in the relevant function|
|Other Specifications||• Good English communication (reading, writing, listening, speaking) |
• Understanding of US healthcare, HIPAA
• Good at MS Office
• Experience in using RCM Software
• Capable of task execution based on work instructions