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 and Requirements
• 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.
