Senior Executive - Operations

• Review and analyze the assigned outstanding receivables portfolio to identify unresolved claims.

• Manage and resolve outstanding and denied claims by coordinating effectively with insurance companies.

• Follow up promptly to obtain additional information required for claim resolution.

• Ensure all claims are resolved within established timelines and adhere to defined Service Level Agreements (SLAs).

• Perform website checks and handle non-callable denials to optimize receivables recovery.

Skills and abilities

• Working on website related claims and action based on coding team responses.

• All non-callable denials, demographic and eligibility denials need to be worked

• Ensure Daily Productivity targets are met at the required quality level on the assigned inventory.

• Perform timely follow up on claims to avoid revenue loss, Prioritize the pending claims for calling from the aging bucket

• Review claims that have not been paid by insurance companies.

• Check insurance information provided by patient if it is insufficient or unclear.

Follow the guidelines and applicable rules while calling insurance companies for confidentiality and HIPAA compliance.

• Escalate difficult collection situations to management in a timely manner, Handling patients billing queries and updating their account information.

• Post cash and write off the contractual adjustments accordingly while working on the accounts.

• Meeting daily/weekly and monthly targets set for an individual.

Qualifications: Graduation in any stream

Experience: BPO Experience: 3-6 years

US Healthcare AR experience preferred

Communication Skill: Excellent written (documentation) and oral communication skill