Accounts Receivable Analyst
Mandate to have 2yrs of Acute business with Ambulatory .

Acute Care:

• Immediate and intensive treatment for acute illnesses, injuries, or episodes of chronic illness.
• Typically provided in hospitals, emergency departments, or urgent care settings.

Acute Care Services:

• Emergency surgery
• Intensive care units (ICU)
• Emergency room treatment
• Short hospital stays for medical stabilization

Ambulatory

• Ambulatory patients: Individuals who are able to walk and move about on their own (not bedridden).
• Ambulatory care: Medical care provided to patients who do not require hospitalization.

Ambulatory Surgery:

Also called outpatient surgery, where patients go home the same day after the procedure. Cataract surgery, laparoscopic gallbladder removal.

● 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
● High School (HSC) or graduate or equivalent with strong analytical skills.
● 2+ 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