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Primary Responsibilities:
- 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 assigned
Qualifications/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
