RCM AR Specialist

• Summary-
• Responsible for the overall recovery and management of accounts receivable as it relates to maximizing accounts receivable collections for RCMS clients. The position involves detailed research and follow-up on medical insurance claims and the careful preparation of appeals and responses to efficiently interact with insurance carriers and resolve the claim. Supports the RCMS BUs overall Operations and Client Services by efficiently and effectively driving the accounts receivable process and achieving KPI results.

No budget responsibilities, but must meet established RCM KPIs.

• Work Location - Pune (Work from office)
• Shift Timing - 7.30 PM to 4.30 AM
• -
• Strong customer service skills for client satisfaction and client AR health
• answering client, patient and carrier calls; prompt return and follow up to all interactions; prompt response to requests for information
• Timely management of unpaid claims as assigned, through the use of the clients office management/administrator;
• aging reports; correspondence; Clearinghouse and PM rejections; SharePoint reference/maintenance
• Effectively handle complex payer denials; responsible to ensure that secondary claims are processed and paid
• Monitoring and reconciliation of claims to include:
• Held vouchers
• Unbilled vouchers
• Denial trends
• Patient balance report
• Credits and refunds
• Manage and track information requests to client.
• Answer and resolve all incoming calls and requests in a timely manner.
• Complies with and enforces policies and procedures
• Achieves goals set forth by RCM management regarding error-free work, transactions, processes, productivity and compliance requirements. Specific goals include 1,400 accounts worked per month
• May act as partner for new hires to assist them in learning
• Other duties as assigned

• Extensive knowledge with email, search engines, Internet
• ability to effectively use payer website and Laserfiche; basic competence in use of Microsoft products
• Preferred experience with MS Access and PowerPoint, Crystal reports
• Experience with various billing systems, such as NextGen, Pro, Allscripts, Epic and others
• Knowledge of CPT, ICD10 and modifiers.
• Experience in specialties such as Psychiatry, Internal Medicine, Orthopedics, General Surgery
• Familiar with HMO and IPAs, Medicare Fee for Service Plans and Commercial Payers

• Standard work week or as defined by assignment requirements
• Primarily works in standard office environment or remotely
• May require after-hours, on-call support and/or holidays
• On-call and after hours work during peak times including end of month/quarter/year; during this time PTO is limited to meet business needs

Veradigm believes in empowering our associates with the tools and flexibility to bring the best version of themselves to work. Through our generous benefits package with an emphasis on work/life balance, we give our employees the opportunity to allow their careers to flourish.

• Quarterly Company-Wide Recharge Days
• Peer-based incentive Cheer awards
• Tuition Reimbursement Program

  To know more about the benefits and culture at Veradigm, please visit the links mentioned below: -

• https://veradigm.com/about-veradigm/careers/benefits/
• https://veradigm.com/about-veradigm/careers/culture/
• Veradigm is proud to be an equal opportunity workplace dedicated to pursuing and hiring a diverse and inclusive workforce.
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