Key Responsibilities
- Clearinghouse Monitoring: Daily review and management of clearinghouse portals to capture, sort, and action front-end rejections.
- Direct Payer Communication: Contact insurance companies directly via phone or web portals to investigate complex claim rejections, verify active patient eligibility, and check benefit coverage details.
- Root Cause Analysis: Investigate why claims were rejected by the clearinghouse or payer, distinguishing between demographic errors, missing insurance details, coding discrepancies, and provider credentialing mismatches.
- Claim Correction & Resubmission: Efficiently update and correct patient demographics, insurance policy numbers, CPT/ICD-10 codes, and modifiers within the practice management or EHR software before resubmitting.
- Cross-Functional Collaboration: Partner with internal staff and internal medical coders to address data capture errors and help prevent recurring rejections.
- Tracking & Reporting: Maintain accurate logs of rejected claims, common rejection trends, and resolution turnaround times, providing visibility to billing management.
Qualifications & Skills
- Experience: 1 to 3 years of professional experience in medical billing, revenue cycle operations, or high-volume healthcare administration.
- Technical Proficiency: Hands-on familiarity with major clearinghouses and electronic health record (EHR) / practice management software (e.g., Waystar, Cortex, Epic, Athenahealth, eClinicalWorks, NextGen).
- Data Accuracy: Exceptional attention to detail with strong alphanumeric data entry and verification skills.
- Industry Knowledge: Solid foundational understanding of medical terminology, health insurance structures (Medicare, Medicaid, Commercial), and CMS-1500 claim formats.
- Problem-Solving & Communication: Strong telephone etiquette and interpersonal communication skills for effective payer outreach, alongside analytical capability to diagnose billing errors independently.
- Shift Flexibility: Proven ability and commitment to reliably work the 6:00 PM to 3:00 AM IST night shift schedule.
Education & Credentials
- High school diploma or equivalent required; Associate's degree or general background in healthcare administration or medical billing preferred.
Shift: Night Shift (6:00 PM – 3:00 AM IST)-Remote India
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