Revenue Cycle Management

7 days ago

Quezon City, National Capital Region, Philippines Private Advertiser Full time $90,000 - $120,000 per year

Qualifications:

  • 5+ years of experience in the US healthcare industry with acute and ambulatory billing
  • 5+ years of experience in healthcare revenue cycle management services, with understanding of upstream and downstream
  • Worked as AR representative and effectively implemented the experiential learning in the new hire batches
  • In-depth knowledge of denial management and appeal writing for both administrative and clinical denials
  • In-depth knowledge of Acute and Ambulatory specialties with understanding of associated diagnosis, procedure and denials
  • Comprehensive knowledge of UB04 claim form component, including proper inpatient coding, revenue codes, procedure codes, and regulatory requirement
  • Familiarity with insurance guidelines (Medicare, Medicaid, commercial payers) and their plans
  • Expertise in handling inpatient claims and understanding payment methodologies- DRG classifications, bundled payment models)
  • Proficiency in understanding coding denials and code sets (ICD-10, CPT04, HCPCS) and understanding of medical records
  • Demonstrated ability to analyze AR claim as end to end and identify the root cause and faster resolution
  • Demonstrated ability to handle multiple geos – US/PR/PHL/IND
  • Proven solid analytical and problem-solving skills
  • Proven excellent communication and leadership abilities

Primary Responsibilities:

  • Successful implementation and management of the training department
  • Training fresher, existing and experienced colleagues for all scopes of work in backend business of RCM
  • Delivering training programs to employees using a variety of methods, including classroom instruction, e-learning and on-the-job training
  • Review training needs and performance monthly basis and perform focus group, conduct feedback and monitor progress of the batches till they become productive as 100%
  • Bottom quartile management
  • Plan and implement an effective training curriculum, content and automation
  • Collaborate with management to identify training needs (TNI or TNA) for all employees
  • Regularly connect with ops, quality and training to enhance the training and identify the area of improvement
  • Maintaining up-to-date knowledge of best practices in training and development and making recommendations for changes to training programs as required
  • Be able to raise or track new hire process credentials
  • Be able to work on the accounts for the aligned process to have hands-on experience for better for experiential training
  • Learn new or existing business as end to end and prepare or modifier the training curriculum
  • Be able to align themselves with organization or team or client culture and mission, vision and value
  • Be well equipped in handling in-person and virtual training
  • Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so

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