Senior Executive EXL / SE / 1112967

Job Description

Overview :

Deliver Daily targets for payment posting transactions. (ERA & Manual EOB Posting)

Qualifications :

Graduation in any stream (Preferred science and math background)

Experience :

2-5 Years experience with key domain expertise in Payment posting and denial capturing

US Healthcare BPO Payment posting experience preferred.

Communication Skill :

Strong written (documentation) and oral communication skills

Working Hours :

40 hours per week as Full-time employee

Shift time : Day / Mid Shift

Weekends Off

Telecommuter / Internet requirements, if applicable :

High Speed internet connection at home, must be broadband.

Must understand and adhere with telecommuter policy.

Skills and abilities :

• Ensure Daily Productivity targets are met at the required quality level on the assigned inventory Perform accurate payment posting.
• Process all ERA & Manual EOB’s and reconcile daily / monthly reports for review.
• Process payments in Practice Management System (PMS) as per instructions provided by the client.
• Review and update the patient insurance information in the Practice Management System (PMS)
• Good understanding of downloading the files from the FTP / document management system.
• Strong in reviewing EOB'S and trained in posting both Manual and ERA ( Remits)
• Should have knowledge to identify denial codes (RARC & CARC) with denial reason & Correspondence.
• Should have knowledge in patients’ payment posting, Offset and Refund, “Small Balance Write Off.”
• Should have knowledge in Recoupment and Over Payment / Under Payments, Sequestration and Interest payment / Penalty payments.
• Should have knowledge in Cross Over (Piggy Bag), Capitation Agreement Payments
• Knowledge about Patient’s Responsibility (Copay, Coinsurance & Deductible)
• Knowledge about the Participating and Non-Participating Provider.
• Good understanding on HSA and HRA payments, “Worker’s Comp” and “No Fault”
• User to be proactive in escalating to his supervisor on any new scenarios / challenges identified in the process.
• Tracking and drafting clarifications clean and clear
• Have hands on experience with basic excels, strong analytical skills.
• Flexible as per project and client requirements and good team player
• Readiness for extending shift during month end processing.
• Resources should be from Chennai only (physical location should be Chennai).
• Willing to work from the office as and when required.
• Initial 1 month or 2 work from Chennai office mandatory.
• Require resources for Band A1 and A2.
• Experience criteria- 3-5 years, need productive resource for the next 3 years.
• Hands on experience in NextGen PMS, should be aware of end of end payment posting, managing, and tallying from deposit log.
• Should have hand-on understanding of posting $0 remits and denials in the NextGen PMS.Should have hands-on experience working correspondence and postings.
• Understands all the denials scenarios and interpretation of denial codes in the correspondence / $0 remits.

Criteria and Clause :