Role & responsibilities: Technical Skills: 1. Medical Billing Systems: • Familiarity with popular billing software such as Epic, Cerner, Meditech, NextGen, ClinicalWorks, Modmed, or PHIMed. • Experience with HCFA-1500 forms, UB-04 forms, and other insurance-specific claim forms. 2. Domain Knowledge: • Handle medical billing processes for various insurance types, including Medicare, Medicaid, HMO, commercial insurance, and Workers' Compensation. • Experience in denials management, including identifying denial reasons, appeals process, and follow-up to resolve denials promptly. • Strong understanding of insurance types, including Medicare, Medicaid, HMO, commercial insurance, and Workers' Compensation. • Proficiency in CPT, ICD-10, and Modifiers to assign correct codes and ensure compliance with coding standards. • Demonstrate a basic understanding of revenue cycle management to optimize billing procedures and revenue generation. • Manage denials effectively by identifying reasons for denials, initiating appeals, and following up to ensure resolution and minimize revenue loss. 3. Claim Submission & Denial Management: • Proficient in claim submission through EDI (Electronic Data Interchange) or other methods. • Experience managing claim denials and rejections, appealing denied claims, and identifying the reason behind denials. • Ability to correct errors in coding or documentation to ensure proper reimbursement. 4. Compliance & Regulations: • Deep understanding of HIPAA regulations to ensure patient confidentiality and compliance. • Awareness of insurance payer guidelines, federal/state regulations, and any updates to medical billing practices. • Knowledge of Medicare/Medicaid billing guidelines and commercial payer contracts Preferred candidate profile: Specify required role expertise, previous job experience, or relevant certifications. Perks and benefits: Mention available facilities and benefits the company is offering with this job.
Key Responsibilities : Accurately assign CPT, ICD-10-CM, and HCPCS codes for multiple specialties (e.g., cardiology, radiology, general surgery, orthopedics, gastroenterology, internal medicine, etc.) Review medical records and documentation for completeness and appropriateness of coding. Ensure coding compliance with federal regulations and coding guidelines (CMS, AHA, AMA, etc.) Work closely with billing teams to resolve coding and documentation discrepancies. Maintain coding productivity and quality benchmarks. Participate in audits and provide feedback to improve coding processes. Stay updated with coding guidelines and payer-specific policies. Qualifications : Minimum 1 year of recent experience in ENM & multispecialty medical coding. Certification required: CPC, CCS, or equivalent (AAPC or AHIMA certified). Strong understanding of medical terminology, anatomy, and physiology. Proficiency with EHR/EMR systems and coding software. Ability to work independently and meet deadlines. Preferred Skills : Experience with coding for outpatient and/or inpatient services. Exposure to Risk Adjustment/HCC coding (optional). Excellent communication and analytical skills.
Job Description Should have strong knowledge in RCM and denial management. Candidate must be familiar with CMS1500 form. Should have knowledge on terms like CPTs, Modifiers, ICD codes Should have knowledge on insurance guidelines especially Medicare and Non-Medicare. Good Knowledge on Denial Scenarios Calling agents on claims resolutions and handling the denials for a closure. Ensure 100% follow up on pending claims Ensure deliverables adhere to quality standards Handling daily denials Handling more complex/aged inventory Follow the basic rules as provided on the SOP Education/ Experience Requirements Any Undergraduate/Graduation Degree and above Problem solving skills Strong verbal and written communication skills with the ability to translate information requests into practical output results Should be analytically strong & well versed with RCM benchmarks Excellent Domain Knowledge Requirement Minimum 1 Year experience in AR calling (Physician Billing) Proficiency in Microsoft office tools Willingness to work the night shift Good knowledge of denials Good Know knowledge of RCM
Job Description Should have strong knowledge in RCM and denial management. Candidate must be familiar with CMS1500 form. Should have knowledge on terms like CPTs, Modifiers, ICD codes Should have knowledge on insurance guidelines especially Medicare and Non-Medicare. Good Knowledge on Denial Scenarios Calling agents on claims resolutions and handling the denials for a closure. Ensure 100% follow up on pending claims Ensure deliverables adhere to quality standards Handling daily denials Handling more complex/aged inventory Follow the basic rules as provided on the SOP Education/ Experience Requirements Any Undergraduate/Graduation Degree and above Problem solving skills Strong verbal and written communication skills with the ability to translate information requests into practical output results Should be analytically strong & well versed with RCM benchmarks Excellent Domain Knowledge Requirement Minimum 1 Year experience in AR calling (Physician Billing) Proficiency in Microsoft office tools Willingness to work the night shift Good knowledge of denials Good Know knowledge of RCM
Job Title: Medical Coder (E&M, Denials, Surgery, HCC) Location: Noida Experience Required: Minimum 3 Years in coding and must hold B. Pharma, BDS. M. Pharma degree Company Overview: Jindal Healthcare Who we are and what we do? At Jindal Healthcare, we are a proud member of the renowned OP Jindal Group, we are traditionally known for our leadership in steel manufacturing and heavy industrial work. However, in recent years, weve shifted our focus to providing innovative technology and outsourcing services within the healthcare sector. Our parent company, Jindal X, a subsidiary of Jindal Sawone of the group’s major entities—was founded over 25 years ago. In the past 7-8 years, we've pivoted into providing Revenue Cycle Management (RCM) services and solutions in the U.S., targeting physician groups, regional hospitals, rural hospitals, and small to mid-sized healthcare providers. What sets us apart in the marketplace is two-fold. First, we’ve developed a proprietary tool, HealthX, that enhances the visibility of the revenue cycle process, allowing us to deliver more efficient and insightful solutions compared to other players in the industry. Secondly, we differentiate ourselves by prioritizing output metrics more than traditional outsourcing firms, ensuring better value within competitive price points. Rather than simply focusing on volume (number of claims worked) and audit scores, we integrate a consulting layer into our service offering. This allows us to directly contribute to improving our clients' overall revenue while simultaneously reducing their cost to collect. We launched this division about eight years ago with a joint venture to learn the ins and outs of the revenue cycle. For the past 4-5 years, we’ve independently operated and grown the business, building an onshore presence for sales, marketing, and client services. Our goal is to continue our exponential growth, with plans to double in size every year over the next 3-4 years. About the Role: We are seeking a detail-oriented and qualified Medical Coder with expertise in Evaluation & Management (E&M), Surgery, Denial Management, and HCC (Hierarchical Condition Category) coding. The ideal candidate must hold a B. Pharma, BDS. M. Pharma degree and possess strong knowledge of medical coding guidelines, healthcare documentation, and claim processing. Curious about the role? Let's take a closer look! Key Responsibilities: Review and interpret medical records to assign accurate ICD-10-CM, CPT, HCPCS, and HCC codes for E&M, Surgery, and related services. Perform HCC coding to capture risk adjustment accurately and ensure compliance with CMS/HHS guidelines. Analyze denied claims, identify root causes, and provide corrective actions to reduce denials. Ensure compliance with official coding guidelines (CPT, ICD-10, HCC, CMS, and payer-specific requirements). Collaborate with physicians, auditors, and the revenue cycle team to improve documentation and coding accuracy. Perform coding quality checks and maintain accuracy and productivity standards. Stay updated with coding updates, payer policies, risk adjustment changes, and industry regulations. Support in preparing audit reports and providing feedback to improve coding/documentation practices Experience and Qualifications: B. Pharma, BDS, M. Pharma degree (mandatory). Certification (preferred but not mandatory): CPC, CRC, CCS, or equivalent. Knowledge of ICD-10-CM, CPT, HCPCS, and HCC coding systems. Strong understanding of E&M coding levels, surgical procedures, risk adjustment, and denial management processes. 3-5 years of relevant experience in medical coding or RCM preferred (freshers with strong knowledge may also be considered). Good communication and analytical skills. Proficiency in medical terminology, anatomy, physiology, and pharmacology. Key Skills Required Medical Coding (E&M, Surgery, HCC, Denials) ICD-10-CM, CPT, HCPCS, HCC Denial analysis & resolution Risk Adjustment (RAF/HCC) Attention to detail and accuracy Knowledge of payer guidelines and compliance Why Join Jindal Healthcare: • Innovative Impact: Play a key role in developing a cutting-edge platform that transforms healthcare practices, improving both financial and patient care outcomes. • Collaborative Culture: Join a dynamic team that values innovation, collaboration, and professional growth. • Career Growth: Benefit from professional development opportunities and career advancement within a leading healthcare technology company.
Job Description Should have strong knowledge in RCM and denial management. Candidate must be familiar with CMS1500 form. Should have knowledge on terms like CPTs, Modifiers, ICD codes Should have knowledge on insurance guidelines especially Medicare and Non-Medicare. Good Knowledge on Denial Scenarios Calling agents on claims resolutions and handling the denials for a closure. Ensure 100% follow up on pending claims Ensure deliverables adhere to quality standards Handling daily denials Handling more complex/aged inventory Follow the basic rules as provided on the SOP Education/ Experience Requirements Any Undergraduate/Graduation Degree and above Problem solving skills Strong verbal and written communication skills with the ability to translate information requests into practical output results Should be analytically strong & well versed with RCM benchmarks Excellent Domain Knowledge Requirement Minimum 1 Year experience in AR calling (Physician Billing) Proficiency in Microsoft office tools Willingness to work the night shift Good knowledge of denials Good Know knowledge of RCM
Job Description Should have strong knowledge in RCM and denial management. Candidate must be familiar with CMS1500 form. Should have knowledge on terms like CPTs, Modifiers, ICD codes Should have knowledge on insurance guidelines especially Medicare and Non-Medicare. Good Knowledge on Denial Scenarios Calling agents on claims resolutions and handling the denials for a closure. Ensure 100% follow up on pending claims Ensure deliverables adhere to quality standards Handling daily denials Handling more complex/aged inventory Follow the basic rules as provided on the SOP Education/ Experience Requirements Any Undergraduate/Graduation Degree and above Problem solving skills Strong verbal and written communication skills with the ability to translate information requests into practical output results Should be analytically strong & well versed with RCM benchmarks Excellent Domain Knowledge Requirement Minimum 1 Year experience in AR calling (Physician Billing) Proficiency in Microsoft office tools Willingness to work the night shift Good knowledge of denials Good Know knowledge of RCM
Job Title: AR Analyst Location: Noida Employment Type: Full-Time Company Overview: Jindal Healthcare Who we are and what we do? At Jindal Healthcare, we are a proud member of the renowned OP Jindal Group, we are traditionally known for our leadership in steel manufacturing and heavy industrial work. However, in recent years, weve shifted our focus to providing innovative technology and outsourcing services within the healthcare sector. Our parent company, Jindal X, a subsidiary of Jindal Sawone of the groups major entitieswas founded over 25 years ago. In the past 7-8 years, we've pivoted into providing Revenue Cycle Management (RCM) services and solutions in the U.S., targeting physician groups, regional hospitals, rural hospitals, and small to mid-sized healthcare providers. What sets us apart in the marketplace is two-fold. First, weve developed a proprietary tool, HealthX, that enhances the visibility of the revenue cycle process, allowing us to deliver more efficient and insightful solutions compared to other players in the industry. Secondly, we differentiate ourselves by prioritizing output metrics more than traditional outsourcing firms, ensuring better value within competitive price points. Rather than simply focusing on volume (number of claims worked) and audit scores, we integrate a consulting layer into our service offering. This allows us to directly contribute to improving our clients' overall revenue while simultaneously reducing their cost to collect. We launched this division about eight years ago with a joint venture to learn the ins and outs of the revenue cycle. For the past 4-5 years, weve independently operated and grown the business, building an onshore presence for sales, marketing, and client services. Our goal is to continue our exponential growth, with plans to double in size every year over the next 3-4 years. Roles and Responsibilities- Technical Skills: 1. Medical Billing Systems: Familiarity with popular billing software such as Epic, Cerner, Meditech, NextGen, ClinicalWorks, Modmed, or PHIMed. Experience with HCFA-1500 forms, UB-04 forms, and other insurance-specific claim forms. 2. Domain Knowledge: ¢ ¢ ¢ Handle medical billing processes for various insurance types, including Medicare, Medicaid, HMO, commercial insurance, and Workers' Compensation. Experience in denials management, including identifying denial reasons, appeals process, and follow-up to resolve denials promptly. Strong understanding of insurance types, including Medicare, Medicaid, HMO, commercial insurance, and Workers' Compensation. ¢ ¢ ¢ Proficiency in CPT, ICD-10, and Modifiers to assign correct codes and ensure compliance with coding standards. Demonstrate a basic understanding of revenue cycle management to optimize billing procedures and revenue generation. Manage denials effectively by identifying reasons for denials, initiating appeals, and following up to ensure resolution and minimize revenue loss. 3. Claim Submission & Denial Management: ¢ ¢ Proficient in claim submission through EDI (Electronic Data Interchange) or other methods. Experience managing claim denials and rejections, appealing denied claims, and identifying the reason behind denials. ¢ Ability to correct errors in coding or documentation to ensure proper reimbursement. 4. Compliance & Regulations: ¢ ¢ Deep understanding of HIPAA regulations to ensure patient confidentiality and compliance. Awareness of insurance payer guidelines, federal/state regulations, and any updates to medical billing practices. ¢ Knowledge of Medicare/Medicaid billing guidelines and commercial payer contracts. a Soft Skills: 1. Analytical Thinking & Problem Solving: ¢ ¢ Strong ability to analyze AR aging reports and identify patterns in denied claims or underpayments. Ability to develop solutions for recurring issues by investigating root causes and collaborating with cross-functional teams. 2. Attention to Detail: ¢ ¢ Precision in reviewing and processing claims to ensure all necessary information is provided, reducing the likelihood of rejections. Ability to identify discrepancies or errors in claims data and take corrective actions quickly. 3. Communication Skills: ¢ Strong verbal and written communication skills to interact with insurance companies, healthcare providers, and patients. ¢ ¢ Ability to explain billing and claims issues clearly to patients or healthcare providers. Good interpersonal skills to maintain effective working relationships with external parties (e.g., payers, customers) and internal teams. 4. Time Management & Organization: ¢ ¢ Ability to handle multiple claims, follow up on overdue payments, and prioritize urgent issues in a busy environment. Managing deadlines for claims follow-ups and appeals while maintaining accurate documentation. Additional Skills: 1. Patient Billing & Collection: ¢ ¢ Experience handling patient billing inquiries, payment arrangements, and explaining charges to patients. Knowledge of patient statements, explanation of benefits (EOBs), and processing patient payments. 2. Knowledge of Reimbursement Rates: ¢ Understanding of contractual agreements with insurance companies and the ability to apply the correct reimbursement rates. 3. Critical Thinking: ¢ Ability to assess complex billing scenarios and come up with effective solutions (e.g., multiple payers, complex claim issues, etc.). 4. Adaptability: ¢ ¢ ¢ Ability to stay updated on changes in coding standards, payer policies, and government regulations. Flexible in adjusting to evolving requirements in medical billing processes and payer requirements. Working knowledge of HIPAA and healthcare compliance. 5. Team Collaboration: ¢ Ability to work as part of a team, particularly with coding specialists, providers, and other departments, to ensure claims are processed correctly. Additional Software/Tools Knowledge: ¢ ¢ ¢ Microsoft Excel for data analysis and reporting. AR Aging Reports and understanding their components (e.g., Current, 30-60-90+ Days, etc.). Revenue Cycle Management (RCM) tools for tracking claim status and financial performance. Key Performance Indicators (KPIs) for AR Analysts in Medical Billing: ¢ ¢ ¢ ¢ Days Sales Outstanding (DSO) Time taken to collect payment after a service is provided. Claim Denial Rate Percentage of claims rejected or denied. First Pass Resolution Rate Percentage of claims processed without needing corrections. Collections Percentage Total collections compared to expected collections.
Job Title: AR Analyst Location: Noida Employment Type: Full-Time Company Overview: Jindal Healthcare Who we are and what we do? At Jindal Healthcare, we are a proud member of the renowned OP Jindal Group, we are traditionally known for our leadership in steel manufacturing and heavy industrial work. However, in recent years, weve shifted our focus to providing innovative technology and outsourcing services within the healthcare sector. Our parent company, Jindal X, a subsidiary of Jindal Sawone of the groups major entitieswas founded over 25 years ago. In the past 7-8 years, we've pivoted into providing Revenue Cycle Management (RCM) services and solutions in the U.S., targeting physician groups, regional hospitals, rural hospitals, and small to mid-sized healthcare providers. What sets us apart in the marketplace is two-fold. First, weve developed a proprietary tool, HealthX, that enhances the visibility of the revenue cycle process, allowing us to deliver more efficient and insightful solutions compared to other players in the industry. Secondly, we differentiate ourselves by prioritizing output metrics more than traditional outsourcing firms, ensuring better value within competitive price points. Rather than simply focusing on volume (number of claims worked) and audit scores, we integrate a consulting layer into our service offering. This allows us to directly contribute to improving our clients' overall revenue while simultaneously reducing their cost to collect. We launched this division about eight years ago with a joint venture to learn the ins and outs of the revenue cycle. For the past 4-5 years, weve independently operated and grown the business, building an onshore presence for sales, marketing, and client services. Our goal is to continue our exponential growth, with plans to double in size every year over the next 3-4 years. Roles and Responsibilities- Technical Skills: 1. Medical Billing Systems: Familiarity with popular billing software such as Epic, Cerner, Meditech, NextGen, ClinicalWorks, Modmed, or PHIMed. Experience with HCFA-1500 forms, UB-04 forms, and other insurance-specific claim forms. 2. Domain Knowledge: ¢ ¢ ¢ Handle medical billing processes for various insurance types, including Medicare, Medicaid, HMO, commercial insurance, and Workers' Compensation. Experience in denials management, including identifying denial reasons, appeals process, and follow-up to resolve denials promptly. Strong understanding of insurance types, including Medicare, Medicaid, HMO, commercial insurance, and Workers' Compensation. ¢ ¢ ¢ Proficiency in CPT, ICD-10, and Modifiers to assign correct codes and ensure compliance with coding standards. Demonstrate a basic understanding of revenue cycle management to optimize billing procedures and revenue generation. Manage denials effectively by identifying reasons for denials, initiating appeals, and following up to ensure resolution and minimize revenue loss. 3. Claim Submission & Denial Management: ¢ ¢ Proficient in claim submission through EDI (Electronic Data Interchange) or other methods. Experience managing claim denials and rejections, appealing denied claims, and identifying the reason behind denials. ¢ Ability to correct errors in coding or documentation to ensure proper reimbursement. 4. Compliance & Regulations: ¢ ¢ Deep understanding of HIPAA regulations to ensure patient confidentiality and compliance. Awareness of insurance payer guidelines, federal/state regulations, and any updates to medical billing practices. ¢ Knowledge of Medicare/Medicaid billing guidelines and commercial payer contracts. a Soft Skills: 1. Analytical Thinking & Problem Solving: ¢ ¢ Strong ability to analyze AR aging reports and identify patterns in denied claims or underpayments. Ability to develop solutions for recurring issues by investigating root causes and collaborating with cross-functional teams. 2. Attention to Detail: ¢ ¢ Precision in reviewing and processing claims to ensure all necessary information is provided, reducing the likelihood of rejections. Ability to identify discrepancies or errors in claims data and take corrective actions quickly. 3. Communication Skills: ¢ Strong verbal and written communication skills to interact with insurance companies, healthcare providers, and patients. ¢ ¢ Ability to explain billing and claims issues clearly to patients or healthcare providers. Good interpersonal skills to maintain effective working relationships with external parties (e.g., payers, customers) and internal teams. 4. Time Management & Organization: ¢ ¢ Ability to handle multiple claims, follow up on overdue payments, and prioritize urgent issues in a busy environment. Managing deadlines for claims follow-ups and appeals while maintaining accurate documentation. Additional Skills: 1. Patient Billing & Collection: ¢ ¢ Experience handling patient billing inquiries, payment arrangements, and explaining charges to patients. Knowledge of patient statements, explanation of benefits (EOBs), and processing patient payments. 2. Knowledge of Reimbursement Rates: ¢ Understanding of contractual agreements with insurance companies and the ability to apply the correct reimbursement rates. 3. Critical Thinking: ¢ Ability to assess complex billing scenarios and come up with effective solutions (e.g., multiple payers, complex claim issues, etc.). 4. Adaptability: ¢ ¢ ¢ Ability to stay updated on changes in coding standards, payer policies, and government regulations. Flexible in adjusting to evolving requirements in medical billing processes and payer requirements. Working knowledge of HIPAA and healthcare compliance. 5. Team Collaboration: ¢ Ability to work as part of a team, particularly with coding specialists, providers, and other departments, to ensure claims are processed correctly. Additional Software/Tools Knowledge: ¢ ¢ ¢ Microsoft Excel for data analysis and reporting. AR Aging Reports and understanding their components (e.g., Current, 30-60-90+ Days, etc.). Revenue Cycle Management (RCM) tools for tracking claim status and financial performance. Key Performance Indicators (KPIs) for AR Analysts in Medical Billing: ¢ ¢ ¢ ¢ Days Sales Outstanding (DSO) Time taken to collect payment after a service is provided. Claim Denial Rate Percentage of claims rejected or denied. First Pass Resolution Rate Percentage of claims processed without needing corrections. Collections Percentage Total collections compared to expected collections.
Job Description Should have strong knowledge in RCM and denial management. Candidate must be familiar with CMS1500 form. Should have knowledge on terms like CPTs, Modifiers, ICD codes Should have knowledge on insurance guidelines especially Medicare and Non-Medicare. Good Knowledge on Denial Scenarios Calling agents on claims resolutions and handling the denials for a closure. Ensure 100% follow up on pending claims Ensure deliverables adhere to quality standards Handling daily denials Handling more complex/aged inventory Follow the basic rules as provided on the SOP Education/ Experience Requirements Any Undergraduate/Graduation Degree and above Problem solving skills Strong verbal and written communication skills with the ability to translate information requests into practical output results Should be analytically strong & well versed with RCM benchmarks Excellent Domain Knowledge Requirement Minimum 1 Year experience in AR calling (Physician Billing) Proficiency in Microsoft office tools Willingness to work the night shift Good knowledge of denials Good Know knowledge of RCM
Job Title: AR Analyst Location: Noida Employment Type: Full-Time Company Overview: Jindal Healthcare Who we are and what we do? At Jindal Healthcare, we are a proud member of the renowned OP Jindal Group, we are traditionally known for our leadership in steel manufacturing and heavy industrial work. However, in recent years, weve shifted our focus to providing innovative technology and outsourcing services within the healthcare sector. Our parent company, Jindal X, a subsidiary of Jindal Sawone of the groups major entitieswas founded over 25 years ago. In the past 7-8 years, we've pivoted into providing Revenue Cycle Management (RCM) services and solutions in the U.S., targeting physician groups, regional hospitals, rural hospitals, and small to mid-sized healthcare providers. What sets us apart in the marketplace is two-fold. First, weve developed a proprietary tool, HealthX, that enhances the visibility of the revenue cycle process, allowing us to deliver more efficient and insightful solutions compared to other players in the industry. Secondly, we differentiate ourselves by prioritizing output metrics more than traditional outsourcing firms, ensuring better value within competitive price points. Rather than simply focusing on volume (number of claims worked) and audit scores, we integrate a consulting layer into our service offering. This allows us to directly contribute to improving our clients' overall revenue while simultaneously reducing their cost to collect. We launched this division about eight years ago with a joint venture to learn the ins and outs of the revenue cycle. For the past 4-5 years, weve independently operated and grown the business, building an onshore presence for sales, marketing, and client services. Our goal is to continue our exponential growth, with plans to double in size every year over the next 3-4 years. Roles and Responsibilities- Technical Skills: 1. Medical Billing Systems: Familiarity with popular billing software such as Epic, Cerner, Meditech, NextGen, ClinicalWorks, Modmed, or PHIMed. Experience with HCFA-1500 forms, UB-04 forms, and other insurance-specific claim forms. 2. Domain Knowledge: ¢ ¢ ¢ Handle medical billing processes for various insurance types, including Medicare, Medicaid, HMO, commercial insurance, and Workers' Compensation. Experience in denials management, including identifying denial reasons, appeals process, and follow-up to resolve denials promptly. Strong understanding of insurance types, including Medicare, Medicaid, HMO, commercial insurance, and Workers' Compensation. ¢ ¢ ¢ Proficiency in CPT, ICD-10, and Modifiers to assign correct codes and ensure compliance with coding standards. Demonstrate a basic understanding of revenue cycle management to optimize billing procedures and revenue generation. Manage denials effectively by identifying reasons for denials, initiating appeals, and following up to ensure resolution and minimize revenue loss. 3. Claim Submission & Denial Management: ¢ ¢ Proficient in claim submission through EDI (Electronic Data Interchange) or other methods. Experience managing claim denials and rejections, appealing denied claims, and identifying the reason behind denials. ¢ Ability to correct errors in coding or documentation to ensure proper reimbursement. 4. Compliance & Regulations: ¢ ¢ Deep understanding of HIPAA regulations to ensure patient confidentiality and compliance. Awareness of insurance payer guidelines, federal/state regulations, and any updates to medical billing practices. ¢ Knowledge of Medicare/Medicaid billing guidelines and commercial payer contracts. a Soft Skills: 1. Analytical Thinking & Problem Solving: ¢ ¢ Strong ability to analyze AR aging reports and identify patterns in denied claims or underpayments. Ability to develop solutions for recurring issues by investigating root causes and collaborating with cross-functional teams. 2. Attention to Detail: ¢ ¢ Precision in reviewing and processing claims to ensure all necessary information is provided, reducing the likelihood of rejections. Ability to identify discrepancies or errors in claims data and take corrective actions quickly. 3. Communication Skills: ¢ Strong verbal and written communication skills to interact with insurance companies, healthcare providers, and patients. ¢ ¢ Ability to explain billing and claims issues clearly to patients or healthcare providers. Good interpersonal skills to maintain effective working relationships with external parties (e.g., payers, customers) and internal teams. 4. Time Management & Organization: ¢ ¢ Ability to handle multiple claims, follow up on overdue payments, and prioritize urgent issues in a busy environment. Managing deadlines for claims follow-ups and appeals while maintaining accurate documentation. Additional Skills: 1. Patient Billing & Collection: ¢ ¢ Experience handling patient billing inquiries, payment arrangements, and explaining charges to patients. Knowledge of patient statements, explanation of benefits (EOBs), and processing patient payments. 2. Knowledge of Reimbursement Rates: ¢ Understanding of contractual agreements with insurance companies and the ability to apply the correct reimbursement rates. 3. Critical Thinking: ¢ Ability to assess complex billing scenarios and come up with effective solutions (e.g., multiple payers, complex claim issues, etc.). 4. Adaptability: ¢ ¢ ¢ Ability to stay updated on changes in coding standards, payer policies, and government regulations. Flexible in adjusting to evolving requirements in medical billing processes and payer requirements. Working knowledge of HIPAA and healthcare compliance. 5. Team Collaboration: ¢ Ability to work as part of a team, particularly with coding specialists, providers, and other departments, to ensure claims are processed correctly. Additional Software/Tools Knowledge: ¢ ¢ ¢ Microsoft Excel for data analysis and reporting. AR Aging Reports and understanding their components (e.g., Current, 30-60-90+ Days, etc.). Revenue Cycle Management (RCM) tools for tracking claim status and financial performance. Key Performance Indicators (KPIs) for AR Analysts in Medical Billing: ¢ ¢ ¢ ¢ Days Sales Outstanding (DSO) Time taken to collect payment after a service is provided. Claim Denial Rate Percentage of claims rejected or denied. First Pass Resolution Rate Percentage of claims processed without needing corrections. Collections Percentage Total collections compared to expected collections.
Job Description Should have strong knowledge in RCM and denial management. Candidate must be familiar with CMS1500 form. Should have knowledge on terms like CPTs, Modifiers, ICD codes Should have knowledge on insurance guidelines especially Medicare and Non-Medicare. Good Knowledge on Denial Scenarios Calling agents on claims resolutions and handling the denials for a closure. Ensure 100% follow up on pending claims Ensure deliverables adhere to quality standards Handling daily denials Handling more complex/aged inventory Follow the basic rules as provided on the SOP Education/ Experience Requirements Any Undergraduate/Graduation Degree and above Problem solving skills Strong verbal and written communication skills with the ability to translate information requests into practical output results Should be analytically strong & well versed with RCM benchmarks Excellent Domain Knowledge Requirement Minimum 1 Year experience in AR calling (Physician Billing) Proficiency in Microsoft office tools Willingness to work the night shift Good knowledge of denials Good Know knowledge of RCM
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