Senior Associate - Gurugram, India - WNS Global Services

Description

Job Description

Serves as the liaison for all insurance questions regarding appropriate plan codes to use and how to accurately update a patient's account and resubmission of claimsShould have hands on experience on Professional Billing concepts like, CMS1500, Medical Coding, Appeals and Denials etc.

Requests documentation from providers to acquire prior authorization for services.
Works on payor correspondence.
Perform timely claim follow up to ensure reimbursement for services.
Effectively work on insurance denials and appeals with knowledge of payor policies guidelines.
Calling Insurance carriers on claims submitted over 31 days. They review acceptance and denial reports from carriers and follow up to obtain current status.

Work with the insurance carrier and the physician's office to secure any medical records that are needed for the insurance company to complete its review Review all medical records on file and are able to discuss with carrier or file an appealReview and work EOBs, mail and checks making the correct determination as to the next stepWork with patients to obtain any needed information as well as to request patientSs help in appealing a denialRequest a peer to peer review as well as contact the Medical Case Managers to discuss medical necessity.

There are instances where they will be contacting the actual Medical Director to discussAppeal accounts that have been denied both over the phone and through letters.

Review payments to make sure they are accurate and balance bill patients appropriately.

They will also make any needed financial adjustments to the file at that timeUpdate any new benefit information, insurance information as well as secondary insurance information as needed and obtainedIdentify discrepancies in cash posting.

Completing AR research request forms when neededReview Payor reports as well as individual accounts for payment and denial trendsMaintain the highest level of quality standards while maintaining the required volume of work production to meet and exceed departmental goalsAdvise management of any and all inter and intra-departmental concerns and issues
Qualifications

Education Qualification Minimum Graduate in any streamGood analytical skillsCandidate should have minimum 1 to 2 years of experience in US Healthcare AR Follow Up, Denials and Collections domain Excellent communication skills written and verbalGood knowledge of MS Office and computer skillsPermanent US shift timings and 100 percent work from office
Additional Information