Job Description

Accounts Receivable Analyst

Mandate to have 2yrs of Acute business with Ambulatory .
Acute Care:Immediate and intensive treatment for acute illnesses, injuries, or episodes of chronic illness. Typically provided in hospitals, emergency departments, or urgent care settings.

Acute Care Services:Emergency surgery Intensive care units (ICU) Emergency room treatment Short hospital stays for medical stabilization

AmbulatoryAmbulatory patients: Individuals who are able to walk and move about on their own (not bedridden). Ambulatory care: Medical care provided to patients who do not require hospitalization.

Ambulatory Surgery:
Also called outpatient surgery, where patients go home the same day after the procedure. Cataract surgery, laparoscopic gallbladder removal.Perform pre-call analysis and check the status by calling the payer or using IVR or web portal services. Maintain adequate documentation on the client software to send the necessary documentation to insurance companies and maintain a clear audit trail for future reference. Record after-call actions and perform post-call analysis for the claim follow-up. Provide accurate information to the insurance company, research available documentation including authorization, physician notes, medical documentation on PM system, interpret explanation of benefits received, etc. prior to making the call. Perform analysis of accounts receivable data and understand the reasons for underpayment, days in A/R, top denial reasons, use appropriate codes to be used in documentation of the reasons for denials/underpayments. Comply with all reimbursement and billing procedures for regulatory, third party, and insurance compliance norms. Responsible for meeting daily/weekly productivity and quality reasonable work expectations.

Responsibilities

Claim processing and submission. Submit the claim to insurance companies to receive payment for services rendered by a healthcare provider. Taking denial status from various insurance carriers Checking eligibility and verification of policy Analysis of the data Converting denials into payments Follow Health Insurance Portability and Accountability Act (HIPAA) Account follow up on fresh claims, denials, and appeals. Checking the claim status as per their suspension and denials Achieving weekly/monthly production and audit target

Qualifications/Requirements

High School (HSC) or graduate or equivalent with strong analytical skills. 2+ Years of experience in accounts receivable follow-up/denial management for US healthcare. Good written and verbal communication skills. Knowledge of medical terminology, ICD10, CPT, and HCPC coding. Basic working knowledge of computers. Willingness to work continuously in night shifts.

Preferred

Familiar with healthcare patient billing systems (Practice management) like NextGen, eCW, Carecloud, Docutap. Familiar with clearinghouse like Waystar, Realmed Availity, change healthcare, via track. Proficiency with MS Excel, MS Word, google spreadsheet, etc.

Other Skills and Abilities

Ability to work independently with minimal supervision. Good analytical skills, assertive in resolving unpaid claims. Ability to multi-task and accurately process high volumes of work. Strong organizational and time management skills
Individual Contributor