Account Receivable, insurance credentialing,eligibility benefits verification

Job Description

Job Position Overview: The Account Receivable (AR) Specialist in Medical Billing and Insurance Credentialing is responsible for managing the collection process, ensuring timely payments, and ensuring the accuracy of medical billing and insurance claims. This role also requires proficiency in eligibility benefits verification and insurance credentialing to support accurate billing processes and to ensure that claims are processed efficiently. Key Responsibilities: Medical Billing & Accounts Receivable Management: Process and review medical claims for accuracy before submission to insurance companies. Post payments and adjustments to patient accounts, ensuring all transactions are accurate and up-to-date. Follow up with insurance companies and patients on outstanding balances or denied claims. Maintain detailed records of payment statuses and track overdue accounts to facilitate timely collections. Review patient and insurance payments to ensure compliance with contracted rates. Insurance Credentialing: Manage and maintain the provider’s insurance credentialing and re-credentialing process. Submit applications for new provider enrollments and follow up on approval status. Work with insurance companies to resolve any issues with provider credentials or billing discrepancies. Eligibility and Benefits Verification: Verify patient insurance coverage and benefits prior to providing services. Confirm eligibility, co-pays, deductibles, and patient out-of-pocket responsibilities by contacting insurance carriers. Assist patients with understanding their insurance coverage and financial responsibilities. Claim Denials & Appeals: Investigate and resolve denied, rejected, or unpaid claims by working with insurance carriers and resubmitting claims or filing appeals when necessary. Ensure that proper documentation is in place to support the appeals process and communicate effectively with insurance representatives to resolve issues. Patient Communication: Communicate with patients regarding their outstanding balances, explaining billing statements and payment plans if necessary. Provide assistance in setting up payment arrangements or determining financial assistance options. Compliance & Documentation: Ensure adherence to all healthcare regulations, including HIPAA, while managing patient information. Maintain accurate, organized, and complete billing documentation in compliance with insurance requirements and healthcare regulations. Stay updated on changes in healthcare regulations, insurance policies, and billing practices. Reporting & Analysis: Generate and review accounts receivable reports to track payment trends, aging balances, and collection progress. Assist in the preparation of financial reports related to billing and collections for the management team. Required Qualifications: High school diploma or equivalent (Associate's or Bachelor's degree in Healthcare Administration or related field preferred). Minimum of 2-3 years of experience in medical billing, accounts receivable, or healthcare finance. Familiarity with medical insurance carriers, claims processing, and eligibility verification procedures. Experience with medical billing software and electronic health record (EHR) systems (e.g., Epic, AthenaHealth, Cerner). Knowledge of insurance terminology, coding (ICD-10, CPT), and regulatory guidelines such as HIPAA. Strong organizational, communication, and problem-solving skills. Ability to manage multiple priorities and meet deadlines in a fast-paced environment. Desired Skills: Previous experience in insurance credentialing and provider enrollment. Ability to handle complex billing and insurance inquiries. Proficient with Microsoft Office Suite (Excel, Word, Outlook). Work Environment: Office setting with potential for remote work depending on the organization’s policies. Compensation: Competitive salary based on Benefits Job Type: Full-time Pay: ₹25,000.00 - ₹35,000.00 per month Schedule: Monday to Friday Night shift US shift Work Location: In person