Associate Operations

Candidate should have minimum 1 year of experience in US Healthcare collections domain with excellent communication skills Excellent communication skills – written and verbal Good knowledge of MS Office and computer skills Permanent evening US shift – 5 days working (Depends on the process requirement) Education Qualification : Minimum Graduate (in any stream) Brief description of Role and responsibility: 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 appeal Review and work EOBs, mail and checks making the correct determination as to the next step Work with patients to obtain any needed information as well as to request a patients help in appealing a denial. Request 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 discuss Appeal accounts that have been denied both over the phone and through letters. Work with the Sales Force to assist in obtaining any additional information that may be required to ensure payment of the claim 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 time Review accounts to be certain they are in accordance with Client’s Corporate Compliance Policy Update any new benefit information, insurance information as well as secondary insurance information as needed and obtained. Identify discrepancies in cash posting. Completing A/R research request forms when needed. Review Payor reports as well as individual accounts for payment and denial trends Maintain the highest level of quality standards while maintaining the required volume of work production to meet and exceed departmental goals. Advise management of any and all inter and intra-departmental concerns and issues. Qualifications Graduate Other details: Should be ok for 24*7 shifts Should be ok to work from office Salary upto 4.5 LPA Interested candidates can share their CV at akshya.tiwari@wns.com or call at # 9899974386