Senior Executive - Operations

• 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