Accounts Receivable Analyst - Hospital Billing

Accounts Receivable Analyst

• ● Perform pre-call analysis and check the status by calling the payer or using IVR or web portal services.
• ● Maintain adequate documentation on the client software to send the necessary documentation to insurance companies and maintain a clear audit trail for future reference.
• ● Record after-call actions and perform post-call analysis for the claim follow-up.
• ● Provide accurate information to the insurance company, research available documentation including authorization, physician notes, medical documentation on PM system, interpret explanation of benefits received, etc. prior to making the call.
• ● Perform analysis of accounts receivable data and understand the reasons for underpayment, days in A/R, top denial reasons, use appropriate codes to be used in documentation of the reasons for denials/underpayments.
• ● Comply with all reimbursement and billing procedures for regulatory, third party, and insurance compliance norms.
• ● Responsible for meeting daily/weekly productivity and quality reasonable work expectations.
• Responsibilities
• ● Claim processing and submission.
• ● Submit the claim to insurance companies to receive payment for services rendered by a healthcare provider.
• ● Taking denial status from various insurance carriers
• ● Checking eligibility and verification of policy
• ● Analysis of the data
• ● Converting denials into payments
• ● Follow Health Insurance Portability and Accountability Act (HIPAA)
• ● Account follow up on fresh claims, denials, and appeals.
• ● Checking the claim status as per their suspension and denials
• ● Achieving weekly/monthly production and audit target
• Qualifications/Requirements
• ● Any Graduate or equivalent with strong analytical skills.
• ● 1+ Years of experience in accounts receivable follow-up/denial management for US healthcare.
• ● Good written and verbal communication skills.
• ● Knowledge of medical terminology, ICD10, CPT, and HCPC coding.
• ● Basic working knowledge of computers.
• ● Willingness to work continuously in night shifts.
• Preferred
• ● Familiar with healthcare patient billing systems (Practice management) like NextGen, eCW, Carecloud, Docutap.
• ● Familiar with clearinghouse like Waystar, Realmed Availity, change healthcare, via track.
• ● Proficiency with MS Excel, MS Word, google spreadsheet, etc.
• Other Skills and Abilities
• ● Ability to work independently with minimal supervision.
• ● Good analytical skills, assertive in resolving unpaid claims.
• ● Ability to multi-task and accurately process high volumes of work.
• ● Strong organizational and time management skills

Individual Contributor