RCM AR Specialist

The primary purpose of this role is responsibility for the overall recovery and management of accounts receivable as it relates to maximizing collections for clients. The position involves detailed research and follow-up on medical insurance claims and the careful preparation of appeals and responses to efficiently interact with insurance carriers and resolve the claim. The position supports the company's overall Operations and Client Services by efficiently and effectively driving the accounts receivable process and showing results.

Main Duties:

• Timely management and resolution of unpaid claims as assigned
• Effectively manage complex payer denials by assimilating and submitting:
• • Supporting client clinical documentation
  • Payer criteria
  • Correct coding guidelines
  • Specialty Association recommendations
  • Federal/local regulatory guidelines
  • Supporting letter of medical necessity from the provider of service
  • Appeal letter consistent with payer requirements
  • Other documentation as applicable
• Timely resolution of denials including follow up with payers and clients
• Responsibility for information necessary to resolve claims is the responsibility of the AR representative.
• • Consistent and timely follow up with the client to provide clarification and/or missing information is critical.
• Adherence to the Client Adjustment Authorization matrix using appropriate adjustment codes to ensure clean AR
• Secondary claims management

• Monitoring and reconciliation of claims to include:
• Held vouchers
• Unbilled vouchers
• Patient balance report
• Credits and refunds

• Compliance with and enforcement of ASRCMS policies and procedures and Client specific billing guidelines
• Achieve goals set forth by supervisor regarding error-free work, transactions, processes and compliance requirements
• Specific goals include 1,400 accounts worked per month
• Other duties as assigned

An Ideal Candidate will have:

• Technical: Extensive knowledge on use of email, search engine, Internet; ability to effectively use payer websites and Laserfiche; knowledge and use of Microsoft Products: Outlook, Word, Excel. Preferred experience with various billing systems, such as NextGen, Pro and Allscripts.

  Personal: Strong written, oral, and interpersonal communication skills; Ability to present ideas in business-friendly and user-friendly language; Highly self-motivated, self-directed, and attentive to detail; team-oriented, collaborative; ability to effectively prioritize and execute tasks in a high-pressure environment.

  Communication: Ability to read, analyze and interpret complex documents. Ability to respond effectively to sensitive inquiries or complaints from employees and clients. Ability to speak clearly and to make effective and persuasive arguments and presentations.

  Math & Reasoning:

  Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to use critical thinking skills to apply principles of logic and analytical thinking to practical problems.

Academic Qualifications:

• High School Diploma or GED
• 3+ years of physician billing experience required

Work Arrangements: Work from Pune Office

Shift Timing: (US Shift - 7:30 PM IST to 4:30AM IST)

Benefits

Veradigm believes in empowering our associates with the tools and flexibility to bring the best version of themselves to work. Through our generous benefits package with an emphasis on work/life balance, we give our employees the opportunity to allow their careers to flourish.

• Quarterly Company-Wide Recharge Days
• Peer-based incentive "Cheer" awards
• "All in to Win" bonus Program
• Tuition Reimbursement Program

To know more about the benefits and culture at Veradigm, please visit the links mentioned below: -

https://veradigm.com/about-veradigm/careers/benefits/

https://veradigm.com/about-veradigm/careers/culture/