Account Receivables Analyst (Ambulatory)

Accounts Receivable Analyst  

● 3 Years of experience in accounts receivable follow-up/denial management for US healthcare.

● Mandate Ambulatory experience of 3 years.

● Candidate should have hands on experience in CMS-1500 Billing- Professional Billing experience.

● Candidate should have knowledge of appeals process of various US Healthcare insurance companies.

● 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 targetQualifications/Requirements● High School (HSC) or graduate or equivalent with strong analytical skills.● 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

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