Senior Executive - Operations

Job Description

Review and analyze the assigned outstanding receivables portfolio to identify unresolved claims.

Manage and resolve outstanding and denied claims by coordinating effectively with insurance companies.

Follow up promptly to obtain additional information required for claim resolution.

Ensure all claims are resolved within established timelines and adhere to defined Service Level Agreements (SLAs).

Perform website checks and handle non-callable denials to optimize receivables recovery.

Responsibilities

Skills and abilities

Working on website related claims and action based on coding team responses.

All non-callable denials, demographic and eligibility denials need to be worked

Ensure Daily Productivity targets are met at the required quality level on the assigned inventory.

Perform timely follow up on claims to avoid revenue loss, Prioritize the pending claims for calling from the aging bucket

Review claims that have not been paid by insurance companies.

Check insurance information provided by patient if it is insufficient or unclear.

Follow the guidelines and applicable rules while calling insurance companies for confidentiality and HIPAA compliance.

Escalate difficult collection situations to management in a timely manner, Handling patients billing queries and updating their account information.

Post cash and write off the contractual adjustments accordingly while working on the accounts.

Meeting daily/weekly and monthly targets set for an individual.

Qualifications

Qualifications: Graduation in any stream

Experience

BPO Experience: 3-6 years

US Healthcare AR experience

Communication Skill

Excellent written (documentation) and oral communication skill