Secure Health Solutions

Akota, Vadodara

The JobResponsible for calling Insurance companies (in US) on behalf of doctors/physicians and follow up on outstanding Accounts Receivable. To prioritize the pending claims for calling from the aging basket.Should be able to convince the claims company (payers) for payment of their outstanding claims.To check the appropriateness of the insurance information given by the patient if it is inadequate or unclear. To make a physical call by following the international norms and applicable rules for confidentiality and HIPAA compliance.Escalate difficult collection situations to management in a timely manner. Review provider claims that have not been paid by insurance companies.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. Desired Profile: Should be willing to work in US Shift. Minimum 6 Months Experience in Healthcare Revenue Cycle Management process.Strong written and verbal communication skills. Good computer skills including Microsoft Office suite.Ability to prioritize and manage work queue.Ability to work independently as well as in a team environment.Strong analytical and problem-solving skills. Good typing skills with a speed of min 30-35 words /min

The JobMajor Duties and Accountabilities:Handles inbound telephone and written inquiries from providers and staff regarding prior authorization by screening and reviewing requests based on benefit plan design, client specifics and clinical criteria.Provides information to patients, participants, pharmacists and doctors regarding participants benefit coverage.Facilitates resolution of prior authorization issues and pro-actively addresses researches and resolves issues while maintaining accurate and complete documentation of all inquiries.Obtains prior authorization for non-formulary medications.Assists the patients in obtaining appointments with specialists and acquiring special medical procedures.Assists in obtaining appointments for hospital follow-ups.Maintains ongoing tracking and appropriate documentation on referrals.Communicates professionally and respectfully to Insurance companies acting as a patient advocate and representing the clinic professionally.Communicates with clinical staff on any issues or need for further follow up.Contacts the patients regarding any pending referrals, and or diagnostic testing.Faithfully documents and retains all communication regarding the referral/authorization process.Works collaboratively with other associates and managers to ensure that best practices are shared.Maintains knowledge of resource materials such as medical dictionary, policy/procedure manual, employee handbooks, and organizational chart.Complies with policy and procedure manual of the clinic.Provides calm, reassuring atmosphere and communicates effectively with patients, staff, physicians, and other guests.Performs other related duties as assigned.Performs procedures according to the LMC policies and procedures as noted on skills check list/competency.Other jobs as assigned.