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