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RCM AR Specialist

Allscripts(India) LLP, ultimately a subsidiary of Altera Digital Health Inc.,[Altera India]

3 - 8 years

5 - 10 Lacs

kolkata mumbai new delhi hyderabad pune chennai bengaluru

Posted:None| Platform:

Apply

Skills Required

claims coding analytical reconciliation billing healthcare appeals medical insurance microsoft monitoring

Work Mode

Work from Office

Job Type

Full Time

Job Description

Veradigm

The primary purpose of this role is responsibility for the overall recovery and management of accounts receivable as it relates to maximizing collections for clients. The position involves detailed research and follow-up on medical insurance claims and the careful preparation of appeals and responses to efficiently interact with insurance carriers and resolve the claim. The position supports the company s overall Operations and Client Services by efficiently and effectively driving the accounts receivable process and showing results.

Main Duties:

Timely management and resolution of unpaid claims as assigned
Effectively manage complex payer denials by assimilating and submitting:

Supporting client clinical documentation
Payer criteria
Correct coding guidelines
Specialty Association recommendations
Federal/local regulatory guidelines
Supporting letter of medical necessity from the provider of service
Appeal letter consistent with payer requirements
Other documentation as applicable

Timely resolution of denials including follow up with payers and clients
Responsibility for information necessary to resolve claims is the responsibility of the AR representative.

Consistent and timely follow up with the client to provide clarification and/or missing information is critical.

Adherence to the Client Adjustment Authorization matrix using appropriate adjustment codes to ensure clean AR
Secondary claims management

Monitoring and reconciliation of claims to include:
Held vouchers
Unbilled vouchers
Patient balance report
Credits and refunds

Compliance with and enforcement of ASRCMS policies and procedures and Client specific billing guidelines
Achieve goals set forth by supervisor regarding error-free work, transactions, processes and compliance requirements
Specific goals include 1,400 accounts worked per month
Other duties as assigned

An Ideal Candidate will have:

Technical:
Extensive knowledge on use of email, search engine, Internet; ability to effectively use payer websites and Laserfiche; knowledge and use of Microsoft Products: Outlook, Word, Excel. Preferred experience with various billing systems, such as NextGen, Pro and Allscripts.

Personal:
Strong written, oral, and interpersonal communication skills; Ability to present ideas in business-friendly and user-friendly language; Highly self-motivated, self-directed, and attentive to detail; team-oriented, collaborative; ability to effectively prioritize and execute tasks in a high-pressure environment.

Communication:
Ability to read, analyze and interpret complex documents. Ability to respond effectively to sensitive inquiries or complaints from employees and clients. Ability to speak clearly and to make effective and persuasive arguments and presentations.

Math & Reasoning:

Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to use critical thinking skills to apply principles of logic and analytical thinking to practical problems.

Academic

Qualifications:

High School Diploma or GED
3+ years of physician billing experience required

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Allscripts(India) LLP, ultimately a subsidiary of Altera Digital Health Inc.,[Altera India]

Healthcare Technology

Bangalore

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RCM AR Specialist