Medical Revenue Cycle

Medical Revenue Cycle Management starts when a patient makes an appointment or visits a clinic.

In order to avoid pre-processing errors and improve claim payment accuracy, correct eligibility verification and accurate data entry in claims forms is required.

Regular review of departmental records, reports, and files, transcription, follow-up telephone calls is needed to maintain accurate records and ensure that medical record account entries are up to date.

The Medical Revenue Cycle also requires regular follow ups and check-in to ensure timely & correct payments.

Connext Global Solutions offers excellent Healthcare Outsourcing Solutions. Here is a list of common roles with their accompanying tasks that you can delegate to a Healthcare outsourcing and staffing solutions provider like Connext Global Solutions:

Healthcare Account Manager

The offshore Healthcare account manager acts as the dedicated point of contact of the client and is responsible in overseeing and managing the daily operations of the offshore team. The dedicated account manager provides performance reviews, real-time quality monitoring and feedback sessions. Equipped with management and organizational skills, it is required that the manager has an understanding of US rules, regulations and practices affecting medical billing and insurance verification, has a comprehensive knowledge and understanding of rules, regulations and practices affecting medical billing and insurance verification, revenue cycle, collections and payment posting, medical billing and coding, Medicare and Medicaid, and third-party payers.

Credentialing Specialist

Healthcare Outsourcing roles can also extend to administrative functions such as the credentialing application process. Credentialing Specialists conduct primary source verification and ensure proper and timely handling of credentialing applications of participating providers and are monitored on an ongoing basis. This includes, but is not limited to, providing application assistance, data entry, file audits, requesting information, sanctions, progress and monitoring reports, and maintenance of electronic files.

Medical Billing Specialist

Accurate data entry is provided by Medical Billing specialists The dedicated outreach specialists reach out to respective insurance companies via inbound and outbound calling for collecting payments and insurance verification. They process confidential medical documents and accounts creation, participate in all quality assessment activities and assist to collect and analyze all information and recommend required improvements to all processes and provide follow-up calls for Claims Audit, Claims Follow-up appointments if required.

Claims Adjudicator

The Claims Adjudicator processes claims according to plan documents while applying Company policies and procedures, verifies data entered from the claim form is accurate and complete to enable the claim to be processed correctly and improves claim payment accuracy by identifying pricing and/or submission inconsistencies to management.

Healthcare Support Specialist

Your outsourced Healthcare Support Specialist coordinates and communicates with healthcare providers and patients. They maintain departmental records, reports, and files, communicate delivery setups, make follow-up telephone calls to maintain accurate records, including submittal/return dates and approval periods, and ensure that medical record account entries are up to date.