8 Claims Resolution Jobs

As a part of this role, you will be responsible for working closely with insurance carriers to resolve escalated claims efficiently. You will play a crucial role in driving and influencing change to enhance automation processes. It will be your responsibility to share the results and successes achieved through root cause analysis with the business stakeholders. Your duties will also include reviewing client escalated issues and action items, conducting root-cause analysis, and utilizing this information to improve straight-through processing (STP) and enhance the overall client experience. You will be expected to build and maintain strong relationships with key stakeholders, including regional and global product heads, by keeping them informed of strategic client feedback that can impact the overall client experience and influence the development of the target operating model (TOM) and budgeting process. Additionally, you will be required to confirm daily via the FICC Real Time Matching system, handle repricing and pair-off resolution, investigate and resolve cash/stock record breaks, and confirm affiliate trades and fails with Broker/Dealer. This is a full-time, permanent position suitable for entry-level candidates. The work location for this role is in-person. Benefits include Provident Fund. ,

As an EBO Accounts Receivable professional at Guidehouse in India, you will be responsible for initiating calls to request the status of claims in the queue. It will be your duty to take appropriate actions on claims to ensure resolution, along with ensuring accurate and timely follow-up when necessary. Documenting the actions taken in the claims billing summary notes is also a crucial part of this role. Your tasks will include prioritizing pending claims for calling from the aging basket and making physical calls in accordance with international norms and applicable rules for confidentiality and HIPAA compliance. You will be accountable for working on Denials, Rejections, and LOA's to accounts, and making the required corrections to claims. To qualify for this position, you should hold a Graduate Degree. Guidehouse offers a comprehensive total rewards package, including competitive compensation and a flexible benefits package that underscores our dedication to fostering a diverse and supportive workplace. If you are looking to join a dynamic team at Guidehouse and require accommodation while accessing our website for job-related information or applying for a position, please reach out to Guidehouse Recruiting at RecruitingAccommodation@guidehouse.com. Rest assured, all information you provide will be treated confidentially and used only as needed to facilitate the necessary reasonable accommodation.,

As a member of the EBO Accounts Receivable team in India, you will be responsible for initiating calls to request the status of claims in the queue. Your main tasks will involve taking appropriate actions on claims to ensure timely resolution, accurate follow-up when necessary, and documenting all actions taken in the claims billing summary notes. Additionally, you will prioritize pending claims for calling from the aging basket and make physical calls following international norms and applicable rules for confidentiality and HIPAA compliance. You will also be tasked with working on denials, rejections, LOA's to accounts, and making necessary corrections to claims. To qualify for this role, you must hold a Graduate Degree. While not mandatory, good communication skills would be a nice-to-have for this position. Guidehouse offers a comprehensive total rewards package that includes competitive compensation and a flexible benefits package, reflecting our commitment to fostering a diverse and supportive workplace. If you are interested in joining Guidehouse and require accommodations during the application process, please reach out to Guidehouse Recruiting at RecruitingAccommodation@guidehouse.com. Rest assured that any information you provide will be kept confidential and used only as needed to facilitate the required reasonable accommodations.,

Job Description_ Senior Executive - AR Analyst _ Denial management Job Name: Senior Executive Position Title: Senior Executive - AR Analyst Band: A2 LOB: Denial Management - AR Analyst - RCM Reporting to: Assistant Manager Location/Site: EXL India, Chennai Overview: Review, Analyze and Manage assigned outstanding receivables portfolio by ensuring outstanding/denied claims are resolved, follow up effectively for additional information as needed with insurance companies for claims resolution, follow up with the insurance company on the outstanding/denied claims and resolve them within the timelines and defined Service Level Agreements (SLA's), website checking and working on non-callable denials. Qualifications: Graduation in any stream Experience: BPO Experience : 2-4 years US Healthcare AR experience preferred Communication Skill: Excellent written (documentation) and oral communication skills Working Hours: 40 hours per week as Full-time employee Shift time: Mid Shift Weekends Off Telecommuter/Internet requirements, if applicable: High Speed internet connection at home, must be broadband Must understand and adhere with telecommuter policy Skills and abilities: Working on website related claims and action based on coding team responses. All non-callable denials, demographic and eligibility denials need to be worked Ensure Daily Productivity targets are met at the required quality level on the assigned inventory, Perform timely follow up on claims to avoid revenue loss, Prioritize the pending claims for calling from the aging bucket, Review claims that have not been paid by insurance companies, Check insurance information provided by patient if it is insufficient or unclear, Follow the guidelines and applicable rules while calling insurance companies for confidentiality and HIPAA compliance, Escalate difficult collection situations to management in a timely manner, Handling patients billing queries and updating their account information, Post cash and write off the contractual adjustments accordingly while working on the accounts, Meeting daily/weekly and monthly targets set for an individual.

JOB DESCRIPTION : HOSPITAL RELATIONS MANAGER Department: Hospital Relations Location: Hyderabad,Warangal,Nizamabad,Vijaywada,Visakhapatnam Job Type: Full-Time Job Summary: The Hospital Relations Manager will be responsible for managing and optimizing the relationship between the organization and hospital partners. This role involves overseeing pricing strategies, negotiating claims, resolving pending issues, and ensuring smooth coordination with internal stakeholders. The position also requires meticulous documentation related to training, meetings with internal and external stakeholders and updates to facilitate effective communication and decision-making. Key Responsibilities: 1. Hospital Visit Management: Conduct regular visits to hospital partners to review and address pricing structures, contract terms, and service quality. Analyze and assess hospital billing and pricing strategies to ensure alignment with organizational objectives. 2. Claims Negotiation: Lead negotiations with hospital partners regarding claims and reimbursement issues to ensure favorable outcomes for the organization. Work closely with the internal claims team to resolve discrepancies and expedite claim resolutions. 4. Pending Issues and Concerns: Identify, track, and resolve pending issues and concerns related to hospital partnerships, including billing disputes, service quality, and contractual obligations. Act as a liaison between the hospital and internal teams to address and mitigate concerns promptly. 5. Coordination with Internal Stakeholders: Collaborate with internal departments to ensure alignment on hospital-related activities and strategies. Facilitate effective communication and coordination between internal teams to address issues and implement solutions. 6. Documentation and Reporting: Prepare and maintain comprehensive documentation of hospital visits, pricing agreements, claims negotiations, and issue resolutions. Document and update sales meetings, including key takeaways, action items, and progress reports. 7. Sales Meeting Coordination: Organize and lead sales meetings to discuss hospital partnerships. Provide regular updates and reports to sales teams and management on hospital-related activities and performance. Qualifications: Education: Any Medical Background Minimum of 3 years of experience in hospital relations,Provider Management, healthcare finance, or a similar role. Strong negotiation skills with a proven track record of successful claims resolution. Excellent communication and interpersonal skills to effectively interact with hospital partners and internal teams. Proficiency in Excel, PowerPoint, MS Word. Ability to handle complex issues and provide strategic solutions in a fast-paced environment. Preferred Skills: Experience with hospital billing systems and healthcare reimbursement processes. Knowledge of insurance industry regulations and compliance requirements. Working Conditions: Outdoor visits to hospitals. Flexibility to work outside regular office hours as needed for urgent issues or meetings.

Review and follow up on hospital billing claims for US healthcare providers Understand insurance denials, EOBs, and remittance advice for claim resolution Initiate outbound calls to insurance co Handle denials, underpayments, rejections effectively Required Candidate profile Hands-on exp in AR Calling Hospital Billing domain (US Healthcare). Knowledge of insurance follow-up, CPT/ICD codes, and claim lifecycle Strong understanding of revenue cycle management Excellent comm Perks and benefits Perks and Benefits

JOB DESCRIPTION HOSPITAL RELATIONS MANAGER Job Title: Chief Manager Department: Hospital Relations Location: Pune, Pimpri, Nagpur, Nashik, Kolhapur, Solapur, Aurangabad Job Type: Full-Time Job Summary: The Hospital Relations Manager will be responsible for managing and optimizing the relationship between the organization and hospital partners. This role involves overseeing pricing strategies, negotiating claims, resolving pending issues, and ensuring smooth coordination with internal stakeholders. The position also requires meticulous documentation related to training, meetings with internal and external stakeholders and updates to facilitate effective communication and decision-making. Key Responsibilities: 1. Hospital Visit Management: Conduct regular visits to hospital partners to review and address pricing structures, contract terms, and service quality. Analyze and assess hospital billing and pricing strategies to ensure alignment with organizational objectives. 2. Claims Negotiation: Lead negotiations with hospital partners regarding claims and reimbursement issues to ensure favorable outcomes for the organization. Work closely with the internal claims team to resolve discrepancies and expedite claim resolutions. 4. Pending Issues and Concerns: Identify, track, and resolve pending issues and concerns related to hospital partnerships, including billing disputes, service quality, and contractual obligations. Act as a liaison between the hospital and internal teams to address and mitigate concerns promptly. 5. Coordination with Internal Stakeholders: Collaborate with internal departments to ensure alignment on hospital-related activities and strategies. Facilitate effective communication and coordination between internal teams to address issues and implement solutions. 6. Documentation and Reporting: Prepare and maintain comprehensive documentation of hospital visits, pricing agreements, claims negotiations, and issue resolutions. Document and update sales meetings, including key takeaways, action items, and progress reports. 7. Sales Meeting Coordination: Organize and lead sales meetings to discuss hospital partnerships. Provide regular updates and reports to sales teams and management on hospital-related activities and performance. Qualifications: Bachelors degree in Business Administration, Healthcare Management, Doctor Minimum of 10 years of experience in hospital relations,Provider Management, healthcare finance, or a similar role. Strong negotiation skills with a proven track record of successful claims resolution. Excellent communication and interpersonal skills to effectively interact with hospital partners and internal teams. Proficiency in Excel, PowerPoint, MS Word. Ability to handle complex issues and provide strategic solutions in a fast-paced environment. Preferred Skills: Experience with hospital billing systems and healthcare reimbursement processes. Knowledge of insurance industry regulations and compliance requirements. Working Conditions: Outdoor visits to hospitals. Flexibility to work outside regular office hours as needed for urgent issues or meetings.

Problem solving skills to resolve complex customer inquiries. Demonstrated ability to improve and/or transform team processes. Ability to adapt to changes quickly and think conceptually Billing and resubmitting claims Retrieving necessary documents for billing and account resolution Posting adjustments and resolving credit balances Resolving rejections and denials through corrections and appeals