RCM Associate

Summary

Employed in the medical billing domain, Eligibility Verification Analyst is articulate professionals who communicate with insurance companies and other payers with regards to unpaid claims and assist with actions and information needed to properly review, dispute, or appeal denial until a determination is made to conclude the appeal.

Responsibilities:

• Mandate experience of working in US healthcare domain
• Receive medication referrals and collects insurance information via multiple methods, runs test claims, and completes administrative duties.
• Must have a solid working knowledge of insurance plans and benefit structures to obtain detailed benefit information and maximize plan benefits.
• Review clinical documents for prior authorization/pre-determination submission purposes.
• Contact referral source, patient, and/or doctor's office to obtain additional information that is required to complete verification of benefits or prior approvals.
• Verify and document insurance coverage of medications, administration supplies, and related pharmacy services including prior authorization requirements and coordination of benefits.
• Places outbound calls to patients or doctor's offices to notify of any delays due to more information needed to process or due to prior authorization.
• Provides exceptional customer service to external and internal customers, resolving any customer requests in a timely and accurate manner.
• Ensures the appropriate notification of patients in regards to their financial responsibility, benefit coverage and payer authorization for services to be provided.
• Maintains prior authorizations and verifies insurance coverage for ongoing services.
• Completes all required duties, projects, and reports in a timely fashion on a daily, weekly, or monthly basis per the direction of the leadership.
• Collect, analyze, and record all required demographic, insurance/financial, and clinical data necessary to verify patient information.
• Refer patients to Financial Counselors as needed to finalize payment for services.
• Document financial and pre-certification information according to a defined process on time.
• Request and coordinate financial verification and pre-certification as required to proceed with patient care; Document financial and pre-certification information according to defined process

Skills Required:

• Should possess excellent communication skills.
• Quick and eager to learn and mold accordingly to the process needs.
• Knowledge in Medical Terminology, knowledge of the different types of health insurance plans; i.e.HMO s, PPO s, etc.
• Ability to effectively handle multiple priorities within a changing environment
• Experience in diagnosing, isolating, and resolving complex issues and recommending and implementing strategies to resolve problems.
• Good organizational skills to implement timely follow-up
• Ability to multi-task
• Ability to follow established work schedule

Experience:

• The candidate must have a minimum of 1 year of relevant experience in US Healthcare

Location:

• Noida
• Kolkata

Schedule:

• Night Shift