- Constantly keep track of both electronic and paper claims.
- Review provider claims that have not been paid by insurance companies
- Follow up with insurance companies to understand status of claims. Follow up is done through insurance company/ TPA website or through outbound calls
- Always be watchful for any major rejections or denials from clearing houses/Carriers.
- Based on information received from the insurance company/ TPA, make necessary corrections to the claim and re-file the corrected claim to the insurance company/ TPA
- In case the patient does not have sufficient insurance coverage for the medical procedure or if the patient is in any way not eligible for coverage, transfer the outstanding balance to the patient.
- Constantly watch out for payments and EOBs from major Carriers, pay-to-Address, Provider Numbers etc.
- In case the claim has already been paid by the insurance company, request insurance company/ TPA to send EOB (Explanation of Benefits) through fax/ mail.
- Reduce The AR Days and Increase the Revenue of the Provider(s)
- Ensure the AR days meet Industry Standards.
- Should have basic knowledge of the entire Revenue Cycle Management (RCM)
- Sound knowledge of U.S. Healthcare Domain (Provider side) methods for improvement on the same
Qualification:
Graduates with excellent communication skills.