Job Description

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JOB DESCRIPTION: RCM Denial Management - AR Caller - Quality - Sr Executive
JOB SUMMARY: As a QA RCM, you will be responsible for auditing the work of RCM Callers to ensure the highest standards of service delivery.
REQUIRED EDUCATION/EXPERIENCE:

• Should be Graduate
• Should have worked as a Quality Controller for AR for at least one year with medical billing service providers or should have minimum 5 years' experience into AR
• Must have very good knowledge of medical billing and be confident in process knowledge.
• Experience in the end-to-end Healthcare process and AR team for the audit
• Adapting to new situation challenges whenever required.
• Adhere to all company policies and procedures.

POSITION RELATIONSHIPS:

• Reports directly to the Assistant Manager

JOB RESPONSIBILITIES:

• Review the work performed by AR team and document any quality issues.
• Review call quality issues on various parameters such as conversational skills, claims resolution, and voice quality.
• Participate in developing process documentation.
• Provide feedback and work with the training team to provide remedial training.
• Check the reports developed by AR team - aging analysis, understanding days in A/R, top reasons for denials, etc
• Always be at the forefront of ethical behavior and never be a bystander.

PROFESSIONAL:

• Recognize and respect cultural diversity.
• Adapt communication to an individual's ability to understand. o Use medical terminology appropriately.
• Respond to communications received within a reasonable time frame.
• Project a professional manner and image.
• Adhere to ethical principles.
• Demonstrate initiative and responsibility.
• Work as a team member.
• Efficient Time Management.
• Prioritize and perform multiple tasks.
• Adapt to change, including new hours of operation and methodology.
• Attend functional team meetings and mandatory in-service education.
• Maintain proper observation and adherence to company policies and procedures.

KNOWLEDGE, SKILLS, AND EXPERIENCE:

• Should have worked as a Quality Controller for AR for at least one year with AR providers or should have worked more than 6 years into AR
• Must have very good knowledge of AR and be confident in process knowledge.
• Experience in the end-to-end Healthcare process and AR Team for the audit
• Adapting to new situation challenges whenever required.
• Adhere to all company policies and procedures

LEGAL and COMPLIANCE:

• Maintain patient and company confidentiality.
• Practice within the scope of education, training, and personal capabilities.
• Document company documents (hard copy and electronic) accurately.
• Use appropriate guidelines for releasing information.
• Maintain awareness of US federal and US state health care legislation and regulations, PHI, HIPAA

WORKING HOURS:

• 40 hours per week as Full-time employee
• Shift time: 01:30AM TO 10:30PM IST
• Weekends Off

TELECOMMUTER/INTERNET REQUIREMENT:

• High Speed internet connection at home, must be broadband with minimum of 100 MBPS Speed or above
• Must understand and adhere with telecommuter policy
• Must have power backup at to mitigate power outage

Skills Required