| 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. |
| Level | Individual contributor |
| 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 |