Responsibilities
- Spends 7-8 hours of day making claims calls.
- Documents medical records’ statuses on CollaborateMD and Jira.
- Collect and document claim payment information for approved medical records.
- Conducts medical record follow-up every 2 weeks.
- Communicates medical denials and other necessary escalations to their assigned onshore agent.
- Ensures complete accuracy of information gathered.
- Follows up on and documents appeal statuses, and reports appeal outcomes to their assigned onshore agent.
- Communicates department needs to assigned onshore agent.
- Follow a tier system of following up on medical records, resolving medical record denials, and pulling and compiling medical records
Qualifications
- Strong analytical skills to determine the validity of refund claims and draft appeals effectively.
- Ability to Identify and resolve issues related to refund requests and claim reimbursements in a timely manner.
- Clear and coherent in both written and verbal communication skills to effectively conduct discussions to resolve refund issues and appeals.
- Continuously seeks ways to improve the accuracy and efficiency of refund processing.
- Exhibits sound and accurate judgment in evaluating refund claims and making decisions on whether to approve, deny, or appeal refund requests based on careful consideration of available information.
- Strong time management skills to handle multiple requests and develop realistic action plans to ensure timely and accurate resolution of refund issues.
- Observes safety and security procedures related to handling sensitive payment information to maintain data integrity and confidentiality.
Screening Criteria
- High school diploma or an equivalent combination of education and related work experience.
- No prior professional experience required; however, related experience to medical billing, coding, or healthcare administration are a plus.
- Must have a stable employment history.
