Job Summary: We are seeking an experienced Senior Process Executive to oversee Revenue Cycle Management (RCM) process, including addressing eligibility and benefits, insurance claim backlogs, denials, and Accounts Receivable (AR) follow-up. The ideal candidate will have a proven track record in eligibility and benefits management, authorization management, claims management and process improvement. This role will require a focus on operational excellence, data-driven decision-making, and fostering a culture of accountability within the team. Roles and Responsibilities • Work Accountability o Responsible for addressing RCM insurance claim backlogs, including denials and AR follow-up. o Foster a culture of accountability, efficiency, and continuous improvement. o Conduct regular performance evaluations and implement training initiatives to enhance team skills. o Must have worked on Eligibility Verification, Claims Management, Denial management and appeals. o Must maintain accountability and work towards resolution of the claim. • Operational Excellence in Claims Management o Drive the resolution of Active Outstanding claims by implementing effective prioritization and workflows. o Ensure Total Failed claims remain at minimum levels, utilizing analytics and proactive interventions. o Oversee the resolution of aged claims, maintaining Accounts Receivable >120 days at or below 5%. o Develop and implement policies, procedures, and best practices for claims processing and denial management. o Ensure to complete the target and go beyond every day to improve daily collections. • Key Performance Indicators (KPIs) • Active Denied/No Response claims resolved daily (target: 50). • Work on all denied claims within 48 hours towards resolution. • A/R >120 days maintained at or below 5% and A/R > 90 days maintained below 15%. • Claim denial rates maintained below 5%. • Net Collection Rate (NCR) sustained at 95% or higher. Qualifications • Any Bachelors degree preferred. • Minimum of 3+ years of experience in revenue cycle management, with a proven track record in managing insurance claims, backlogs, authorizations, eligibility and denials. • Extensive knowledge of healthcare billing, coding, and reimbursement processes. • Strong work management skills, with experience managing large, diverse clients. • Proficiency in RCM software, data analytics tools, and advanced Excel functions. • Exceptional problem-solving skills and attention to detail. • Outstanding communication and organizational skills, with the ability to manage multiple priorities effectively. • Willing to work on night shifts (US Timings)
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