An A/R representative is responsible for timely and accurate follow-up and appeal of denials/rejections received from third-party payers. The representative will manage their assigned work to ensure payer appeal/filing deadlines are met and achieve optimal payment for services rendered.
Graduate with 1-5 years’ experience in US health care industry (HB or PB – HB preferred).
Ability to read and interpret insurance explanation of benefits (EOBs
Knowledge of payer edits, rejections, rules, and how to appropriately respond to each.
Accuracy in identifying the cause of rejections/denials and selecting the most appropriate method for resolution.
Demonstrated proficiency with timely and successful appeals to insurance companies
Should have excellent communication skills and the ability to remain pleasant during difficult conversations regarding outstanding bills or debts.
Should have knowledge on terms like CPTs, Modifiers, and ICD code
Should have knowledge on insurance guidelines especially Medicare and Non-Medicare.
Must possess excellent communication and interpersonal skills to work well with patients and claims rep.
MAJOR AREAS OF RESPONSIBILITY
Code of Conduct and Job responsibility
Always works as a team player to provide quality patient care, whether direct or indirect. Within scope of licensure, each employee will assist other team members in accomplishing their job duties in order to “get the job done”.
Job Specific –
Detail oriented and able to deliver neat and organized work.
Self-motivation and ability to demonstrate initiative, excellent time management skills, and organizational capabilities.
Must be able to multi-task in a fast-paced environment and appropriately handle overlapping commitments and deadlines.
Process – Credentialing
Designation: Credentialing and Enrollment Specialist