within the Revenue Cycle Management (RCM) framework. You will work with various teams to ensure that medical claims are processed efficiently and that patient information is managed accurately. The position requires knowledge of medical billing procedures, claim submission, denials, follow-ups, and knowledge of healthcare regulations.

Key Responsibilities

Medical Claims Processing
:

Review and verify patient and insurance details to ensure accurate claim submissions.
Submit medical claims to insurance companies, ensuring all necessary documentation is included.
Process Electronic Data Interchange (EDI) claims and paper claims as per company guidelines.

Denials Management & Follow-up
:

Monitor and resolve denied claims by analyzing rejection codes and taking appropriate corrective actions.
Communicate with payers to follow up on unpaid or underpaid claims and escalate issues when needed.

Billing & Coding Support
:

Ensure medical billing codes (CPT, ICD-10, HCPCS) are accurate for each patient encounter.
Work with coding teams to resolve coding errors and ensure compliant billing practices.

Data Management & Documentation
:

Maintain accurate patient records and update billing systems with relevant information.
Ensure all documentation aligns with healthcare compliance standards.

Client Communication & Reporting
:

Communicate effectively with clients (healthcare providers or payers) regarding billing status and claim issues.
Prepare and submit reports regarding claims status, denials, and outstanding balances.

Compliance
:

Adhere to HIPAA, healthcare regulations, and company policies related to patient confidentiality and data security.
Ensure all billing practices comply with current payer guidelines and regulatory requirements.

Continuous Improvement
:

Participate in training sessions to stay up-to-date with industry trends, new technologies, and billing practices.
Suggest process improvements to enhance efficiency and reduce claim rejections.

MIS Executive:

Prepare and maintain daily, weekly, and monthly MIS reports, dashboards, and performance reports for management and key stakeholders.
Analyze data to identify trends, patterns, and opportunities for process improvement across various departments.
Develop customized reports based on business needs and ensure data accuracy and consistency.
Collect, verify, and analyze data from various internal and external sources to produce accurate reports.
Maintain and update databases and data entry systems to ensure the accuracy of information.
Assist in the development and implementation of MIS tools and reporting formats.
Collaborate with cross-functional teams to gather relevant data for reporting purposes.
Present findings and provide actionable insights through clear and concise reports and presentations.
Support senior management by providing ad-hoc data analysis as required.
Ensure data integrity, confidentiality, and security in all reporting processes.
Monitor key performance indicators (KPIs) and assist in tracking departmental or organizational goals.
Identify and resolve issues related to data accuracy or reporting discrepancies.

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