The article gives an overview of offshore Revenue Cycle Management functions.

Offshoring: An Overview of Offshore Revenue Cycle Management Functions

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

The purpose of Revenue Cycle Management is to provide financial and other related administrative tasks in order to help guarantee the company’s revenues.

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

Offshoring Revenue Cycle Management is important especially for healthcare providers that need additional staff to handle administrative functions such as waiting for an answer to an eligibility question or for a pre-authorization.

There are a several functions in the Medical Revenue Cycle that can be assigned to an offshore revenue cycle management provider.

Roughly 25% of all U.S. hospital spending consists of administrative costs. (Commonwealth Fund)

Offshoring Revenue Cycle Management functions can extend to administrative functions such as data entry, application assistance, file audits, and monitoring reports, and maintenance of electronic files.

Accurate data entry is provided by the Offshore Revenue Cycle Management team. Data entry Specialists process and transcribe data in a systematic manner and properly maintain departmental records, reports, and files. They make a regular review of departmental records, reports and files, follow-up telephone calls to maintain accurate records and ensure that medical record account entries are up to date.

Offshoring revenue cycle management helps minimize the entry errors in processing medical billing and conducting eligibility of insurance verification wherein the offshore team determine whether the patient’s insurance can cover for the services provided.

Claims processing is also one important process when offshoring revenue cycle management. The offshore team can process claims according to plan documents while applying company policies and procedures. They verify that the data entered from the claim form is accurate and complete to enable the claim to be processed correctly by insurance payers.

Offshoring claims processing services can help improve claim payment accuracy and maintain a low backlog of work by properly identifying pricing and/or submission inconsistencies to management.

This involves researching and resolving pre-processing errors and edits to ensure that claims are filed timely. Accurate and timely processing of claim appeals means compliance with the various payor requirements.

The Offshore Revenue Cycle Management team will also handle payment posting which is the processing of incoming payments along with the issuing of necessary paperwork.

Offshore Revenue Cycle Management also requires regular follow ups and check-in to ensure timely & correct payments. This includes generating revenue by working with patients to establish payment schedules for late accounts, following up with them as needed for continued late payments.

Through assigning revenue cycle management services, healthcare providers have an increased focus on the core business process. Read more on how outsourcing medical billing services can unlock growth.

Connext Global Solutions provides Excellent Revenue Cycle Management Solutions

Connext Global Solutions unlocks client growth by equipping healthcare providers fully customized outsourcing solutions by building, training, managing remote offshore teams.

Connext Global Solutions offers excellent Offshore Revenue Cycle Management Solutions. Here is a list of common roles with their accompanying tasks that you can delegate Offshore Revenue Cycle Management 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. The Healthcare Account Manager has management and organizational skills, and 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.

Connext Global Solutions provides Excellent Staffing  Solutions

Aside from providing Healthcare Outsourcing solutions, Connext also provides customized offshore staffing solutions designed to supplement onshore client staff with highly qualified, but lower cost offshore team members personally selected by the client. highly flexible staffing solution.

Clients can build a team of:

• Virtual Nurses
• Certified Public Accountants
• Customer Experience Professionals
• Administrative Assistants
• Web Developers
• Data Analysts
• IT Help Desk or Service Desk Support
• And More

Learn more about Connext Global Solutions.