We are hiring For AR denial management

Job Title:

• Interacts with insurance companies over the telephone, through the mail, email, or fax to resolve issues in regards to collections on accounts.
• Collects outstanding balances by reviewing incoming correspondence and aging reports.
• Analyze denials and correspondence then prepare and process an appeal for additional payment.
• Claim resubmittals.
• Submittal of medical records, LMNs or other requested information in order to satisfy a claim response.

• Forward accounts for adjustments/write-offs and inactivation with appropriate supporting documentation.
• Placing accounts on hold pursuant to information received to avoid any future loss.
• Reviews collection hold reports and audits accounts to resolve any outstanding issues with patients or insurance companies to determine next course of action.
• Meeting designated monthly production and collection goals.
• Updating system with notes, physician information, diagnosis codes, and any other pertinent information required for payment.
• Using carrier resources (web links) to obtain patient claim and coverage information.
• Identifying individual carrier policies, as well as how and why a carrier pays or denies claims.
• Work special projects as assigned

Understand, support and comply with policies, procedures and internal controls in accordance with the best business practices across the organization.

1. Complex Problem-Solving

   : Higher proficiency agents possess the advanced analytical skills necessary to navigate complex issues, such as denials and appeals. Their ability to quickly understand and resolve intricate problems ensures smoother and more effective operations during the pilot phase.

2. Effective Communication

   : Proficient agents excel in communication, essential for interacting with insurance companies, patients, and internal teams. Their ability to articulate issues clearly and professionally helps build strong relationships and facilitates successful collections.

3. Adaptability and Learning

   : A pilot program often involves new procedures and technologies. Agents with higher proficiency can quickly adapt to these changes and learn new systems, ensuring minimal disruption and maximum efficiency.

4. Goal Achievement

   : Meeting designated monthly production and collection goals is crucial for evaluating the pilot programs success. Proficient agents are more likely to achieve these targets due to their experience and skill set, providing reliable data for assessing the program's effectiveness.

5. Attention to Detail

   : The ability to meticulously review and update systems with accurate information is vital. Higher proficiency agents demonstrate exceptional attention to detail, reducing errors and ensuring that all necessary documentation is correctly processed.

6. Initiative and Proactivity

   : Proficient agents often show greater initiative, proactively seeking solutions to improve processes and outcomes. Their proactive approach can drive the pilot program's success, leading to innovations and efficiencies that benefit the entire organization.

7. Stress Management

   : Pilots can be high-pressure environments requiring agents to manage stress effectively. Agents with higher proficiency levels are typically more resilient, maintaining productivity and a positive attitude under pressure.

Competency TypeCompetency DescriptionProficiency Rating (1-5)Technical

1. Unsatisfactory

   : Candidate does not demonstrate competency at an acceptable level.

2. Needs Improvement

   : Candidate shows some understanding but lacks proficiency or experience.

3. Satisfactory

   : Candidate demonstrates basic competency and adequate experience.

4. Good

   : Candidate shows strong understanding and good level of proficiency.

5. Excellent

   : Candidate exhibits exceptional skill and extensive experience.

Total Score RangeRatingDecision

1. Knowledge of insurance company portals and telecommunication methods

• Question

  : Describe your experience with using insurance company portals and telecommunication methods for resolving account issues. Can you provide an example of a challenge you faced and how you overcame it?

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1. Proficiency in claims resubmittals and medical records handling

• Question

  : How do you handle claims resubmittals and the submission of medical records? Can you walk us through a specific case where your actions led to a successful claim resolution?

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1. Familiarity with diagnostic codes and insurance policies

• Question

  : How familiar are you with diagnostic codes and insurance policies? Can you provide an example of how you applied this knowledge in a past role?

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1. Ability to use collection and accounting software

• Question

  : What collection and accounting software have you used in previous roles? Can you describe how you used these tools to improve your workflow?

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1. Data entry and updating systems with pertinent information

• Question

  : Describe your approach to ensuring accurate data entry and updating systems with necessary information. What steps do you take to minimize errors?

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1. Timely collection of outstanding accounts receivables

• Question

  : How do you prioritize and manage your tasks to ensure the timely collection of outstanding accounts receivables?

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1. Analyze denials and prepare/process appeals

• Question

  : Can you describe a time when you successfully analyzed a claim denial and prepared an appeal that led to additional payment?

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1. Forwarding accounts for adjustments/write-offs with supporting documentation

• Question

  : What process do you follow when forwarding accounts for adjustments or write-offs? How do you ensure all supporting documentation is accurate and complete?

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1. Reviewing collection hold reports and auditing accounts

• Question

  : Explain your method for reviewing collection hold reports and auditing accounts. How do you determine the next course of action?

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1. Meeting monthly production and collection goals

• Question

  : How have you consistently met your monthly production and collection goals in previous roles? What strategies do you use to stay on track?

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1. Understanding and compliance with policies and internal controls

• Question

  : How do you stay updated on policies and internal controls? Can you provide an example of how you ensured compliance in a past role?

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1. Effective communication with insurance companies through various channels

• Question

  : How do you ensure effective communication with insurance companies via phone, email, and other channels? Can you share an example of a successful interaction?

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1. Problem-solving and critical thinking to resolve collection issues

• Question

  : Describe a complex collection issue you encountered and the steps you took to resolve it. What was the outcome?

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1. Attention to detail in handling and processing claims and correspondence

• Question

  : How do you ensure accuracy and attention to detail when processing claims and correspondence? Can you provide an example of a time when this attention to detail was crucial?

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1. Collaboration and teamwork to support new and existing team members

• Question

  : Can you describe a situation where you worked collaboratively with your team to support a new member or achieve a common goal?

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1. Adaptability to work on special projects and handle changing priorities

• Question

  : How do you handle changing priorities and adapt to special projects? Can you share an example of a time when you had to quickly adapt to a new situation?

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1. Initiative in securing payments and managing receivables

• Question

  : Give an example of how you took the initiative to secure a payment or improve the management of receivables in a previous role.

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1. Maintaining a positive and professional attitude under pressure

• Question

  : How do you maintain a positive and professional attitude when under pressure? Can you share a specific example where you demonstrated this quality?

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1. English Speaking

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1. English Writing

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1. Mother Tongue Influence (MTI)

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