1 Insurance Verification and Pre-Authorization
Verify patient insurance coverage before admission or procedures.Obtain necessary pre-authorizations and referrals from insurance providers.Communicate coverage limitations or out-of-pocket costs to patients.2 Claims Preparation and SubmissionAccurately input billing data into hospital billing systems (e.g., EPIC, Cerner).Prepare and submit claims to private insurance, Medicare, and Medicaid.Ensure the use of correct diagnosis (ICD) and procedure (CPT/HCPCS) codes.Monitor electronic claim submissions and address transmission errors.3 Claims Follow-Up and Denial ManagementTrack claims to ensure timely processing by payers.Follow up on delayed or unpaid claims.Investigate and resolve denied claims by working with coding teams or submitting appeals.Keep detailed records of communications with insurers.4 Payment Posting and ReconciliationPost insurance payments to patient accounts.Review and reconcile Explanation of Benefits (EOBs) and Electronic Remittance Advices (ERAs).Identify discrepancies in payments and initiate correction or follow-up.5 Patient Account ManagementInform patients of any balances due after insurance processing.Assist patients with understanding their bills and insurance statements.Set up payment arrangements or refer to financial counselors as needed.6 Regulatory ComplianceMaintain compliance with hospital policies, HIPAA, and payer guidelines.Keep current with changes in insurance regulations and billing procedures.Participate in audits and quality assurance reviews as required.7 Interdepartmental CoordinationCollaborate with medical records, coding, admissions, and finance departments.Ensure seamless communication between clinical and billing teams to support revenue cycle integrity.

Skills

Collaboration with Insurance Providers for Reimbursement Documentation
Coordination with Insurance Carriers for Pre certification
Handling Insurance Grievances and Legal Disputes
Explaining Insurance Coverage to Patients
Health Insurance Knowledge
Billing Documentation and Record Keeping
Analyzing Billing Trends and Payment Delays
Communication Skills
System knowledge
Computer skills
Software exposure

More Jobs at NEXTENTI TECH PRIVATE LIMITED

Bio Medical Engineer - Multispecialty Hospital

pune

1.0 - 4.0 yrs

INR 1 - 5 Lacs

Pharmacist

rangareddy

2.0 - 5.0 yrs

INR 1 - 4 Lacs

Billing Executive

kakinada

2.0 - 5.0 yrs

INR 1 - 4 Lacs

Medical lab Technician

hyderabad

Experience: Not specified

INR 1 - 4 Lacs

Pharmacist

chittoor

Experience: Not specified

INR 1 - 4 Lacs

Mock Interview

Practice Video Interview with JobPe AI

Start Job-Specific Interview

Start Your Job Search Today

Browse through a variety of job opportunities tailored to your skills and preferences. Filter by location, experience, salary, and more to find your perfect fit.

Job Application AI Bot

Apply to 20+ Portals in one click

Download Now

Download the Mobile App

Instantly access job listings, apply easily, and track applications.

Enhance Your Skills

Practice coding challenges to boost your skills

Start Practicing Now

NEXTENTI TECH PRIVATE LIMITED

Login to

Please Verify Your Phone or Email

Confirm Action

Billing and Collections Specialist and insurance