Revenue Cycle Professional
1 day ago
Key responsibilities include:
- Monitoring the status of medical claims.
- Investigating rejections and denials.
- Documenting account activities accurately.
- Posting manual payments, applying adjustments, and managing collections from various types of payers.
Additionally, this role requires a deep understanding of eligibility requirements and payment methodologies, as well as the ability to record contractual adjustments in compliance with government regulations and payer contracts.
Job Details- Permanent work from home.
- Monday to Friday | 10:00 PM to 7:00 AM Manila Time.
- Following US Holidays.
- Perform verification of eligibility and benefits to ensure accurate patient coverage.
- Review and submit claims in a timely and compliant manner.
- Obtain prior authorizations to support smooth claim approvals.
- Monitor the status of medical claims and conduct A/R follow-up to ensure prompt and accurate payment.
- Research and resolve claim rejections and denials, implementing measures to prevent future occurrences.
- Generate and submit patient statements (no patient interaction).
- Document all account activities accurately and in a timely manner.
- Post manual payments, apply adjustments, and manage collections from various types of payers.
- Understand and apply Medicare, Medicaid, and commercial insurance eligibility requirements and payment methodologies.
- Correctly record contractual adjustments based on payer contracts and government regulations.
- Exhibit proficiency with billing systems and leverage all functionality to ensure the most efficient processing of claims.
- Maintain up-to-date knowledge of changes in billing and coding guidelines, payer contracts, and government regulations.
- Collaborate with team members and providers, fostering a positive and productive work environment.
- At least 2 years of strong background in end-to-end revenue cycle processes, including eligibility and benefits verification, charge review, claims submission, AR follow-up and denial management, collections, prior authorizations, payment posting, and handling medical records requests.
- Experience in DME and using Apero is preferred.
- Candidates must demonstrate an ability to work collaboratively with team members and healthcare providers.
- Candidates must be able to function in a fast-paced work environment and handle occasional periods of above-average pressure.
- Excellent customer service skills are necessary, as the role involves interacting with various stakeholders, including patients, insurance companies, and healthcare providers.
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