Collaborate with internal RCM and billing departments to ensure we?re meeting payer requirements and assist in the quality assurance review process.
Provide monthly reports on current volume, status and outcomes of both completed and outstanding appointments that are in the QA team work queues.
Assist in reducing rejections from insurance companies to be the minimum ratio and ensure the claims submitted are perfect as per the DHA/HAAD guidelines
Serve as a customer contact on quality issues.
Train employees in the analysis of basic causes of customer complaints and returns, and participate in initiating corrective action.
Create work instructions and operating procedures for new or changed processes, as well as rework instructions for non-standard operations.
Recommends improvements in insurance processing, which will reduce reimbursement turnaround time
Researches denied and improperly processed claims by contacting assigned carriers to ensure proper processing of said claims
Identifies and corrects any claim processing (data entry, verification, coding, resubmission and/or posting) errors
Participates in weekly meetings as requested
Other duties as assignedQualifications/Experience/Skills/Knowledge required for this role:
Certified Coder
Bachelor?s degree in Graduate Degree in Management with experience in Healthcare Insurance and Revenue Cycle Management. (In some cases, an advanced degree may be desirable)
Minimum 5+ years? experience in a similar role, GCC exposure will be an added advantage, Excellent relationship with all major insurance companies.
Experience in RCM Process, clinic & Hospital operations
Proficiency in utilizing and interpreting financial models and analysis
Ability to systematically analyze complex problems, draw relevant conclusions and implement appropriate solution
Strong verbal and written skills, and ability to convey complex information in a way that others can readily follow
