RCM Payment Entry Specialist

Veradigm

Welcome to Veradigm! Our Mission is to be the most trusted provider of innovative solutions that empower all stakeholders across the healthcare continuum to deliver world-class outcomes. Our Vision is a Connected Community of Health that spans continents and borders. With the largest community of clients in healthcare, Veradigm is able to deliver an integrated platform of clinical, financial, connectivity and information solutions to facilitate enhanced collaboration and exchange of critical patient information.

We are an Equal Opportunity Employer. No job applicant or employee shall receive less favorable treatment or be disadvantaged because of their gender, marital or family status, color, race, ethnic origin, religion, disability or age; nor be subject to less favorable treatment or be disadvantaged on any other basis prohibited by applicable law.

For more information, please explore Veradigm.com.

What will your job look like:

Responsible to know and facilitate specific accounts and their unique attributes in order to successfully provide customized Our organizations RCS for each account. This is a dual position with its own workload along with oversight to train, audit and monitor the group for accurate procedures and turnaround. Ensure workflow, including collecting payments stays current and on track with regards to insurance carriers, patients, clients and internal interactions. Supports the overall Operations and Client Services by efficiently and effectively providing and reviewing account data needed for the Revenue Cycle process and delivering results.

Main Duties:

• Strong customer service skills for client satisfaction, health of client AR and guidance for RCS team members
• Answers client calls: prompt return and follow up to all interactions; prompt response to requests for information, both internally and externally.
• Acts as initial point person for team regarding technical work questions/processes/procedures to provide training/guidance.
• Escalates issues to RCS Management related to clients and staff.
• Trains individuals on systems and workflow in order to ensure protocols are followed.
• Reviews and work all unpaid and denied insurance correspondence, both phone appeals and written appeals; confirm all patient demographics and insurance is current and up to date.
• Runs, reviews and works unpaid patient balance reports for payment by reading current notes and place for past due letters and phone calls.
• Prepares insurance/patient correspondence for coworkers by reviewing and batching for further attention and review.
• Prepares and sends uncollected patient payments to collections by writing up forms for the doctors to review.
• Reviews and works insurance and patient overpayments, prepare refund request and send to doctor's office.
• Answers phone calls from insurances and patients.
  
• Organizes, identifies and improves workflow with team members/Management through daily and weekly productivity reports and reports challenges and concerns and requests need for assistance to RCS Management.
• Ability to perform the duties of the Payment Entry Specialist, Charge Entry Specialist, AR Specialist and RCM Specialist roles.
• Keeps manager informed of progress, achievements and issues; assist staff with processes, information and workload.
• Achieve goals set by management and compliance requirements.
  
• Follows, and models adherence to all policies, procedures and processes.
  
• Other duties as assigned.

Academic

• 1+ years relevant work experience (Preferred)

An Ideal Candidate will have:

Compliance

Job responsibilities include fostering the Companys compliance with all applicable laws

and regulations, adherence to the Code of Conduct and Compliance Program

requirements, policies and procedures. Compliance is everyones responsibility.

Knowledge, Skills and Abilities

• Knowledgeable of CPT and ICD coding and medical terminology
• Extensive knowledge with email, search engines, Internet, ability to effectively use payer websites and Laserfiche; basic competence in use of Microsoft products.
• Preferred experience with MS Access and PowerPoint, Crystal reports and various billing systems, such as NextGen, Pro, Epic and others
• Knowledge of CPT, ICD10 and modifiers.
• Experience in specialties such as Psychiatry, Internal Medicine, Orthopedics, General Surgery
• Familiar with HMO and IPAs, Medicare Fee for Service Plans and Commercial Payers
• Strong communication skills

Work Arrangements: Work from Pune Office all 5 days.

Shift Timing: 7:30 PM IST to 4:30 AM IST (US Shift)