rahulthemoksh

Liaison with Quality, Training teams to identify performance gap, devise plans to fulfil these gaps & ensure the implementation of Strategic plans. Ensuring that defined Production, Quality Targets & SLA’s are met. Setting-up & maintaining following scopes – Eligibility, Charges-entry, Rejections, AR & Payment Posting and Credentialing. Analysing the current process output & implementing more advanced mechanism to yield maximum output such as cross training people on various functions. Providing Cross Training to Process Associates to handle High Volume Situations and reduce Idle Time.

Daily review of Ageing in order to identify focus areas to address priority AR Buckets. Assigning the daily assignments (Charges, Eligibility, Payment, Correspondence & AR) to team. Maintaining Team production, attendance, Leave report. Resolving the Team query. Team motivation & Team leading. Monthly review with Team in regards to their individual performance. Worked on Process transitions from Onshore to Offshore. Learning PMS for various clients & Educating team members on same. Checking Credentialing for New clients. Creating the process SOP & maintaining them periodically. Client calls & resolving various client queries as well as updating them about overall Collections, AR Reduction & Collection forecasting. Generating & Maintaining various reports such as AR (Ageing) report, daily, monthly charges & payment report. Doing root cause analysis. Participate in Weekly/Monthly Business health review & Financial dashboard review with Managers.

Sampling and testing of assignments completed by Associates. Keep a check on All the duties carried out to Omit HIPPA violation. Preparing Quality reports, including analytical reports. Creating and executing method development and method validation test protocols. Supporting all QC activities Like Root cause analysis & Side by side audit. Ensuring that procedures are carried out carefully and accurately to eliminate errors. Ensuring good relations and communication with members of the team and responding to Queries within timely fashion to Intra & Internal Department. Working with all members of staff to maintain and develop the positive progressive culture within The Organization. Observing and complying with Organization’s Standard Operating Procedures (SOPs).

AR Follow up, Findings the issues & Providing the solutions for same, Team management, Working on Denials, Clearing houses & Payer Rejections.

I'm responsible to call insurance companies in USA like Medicare. Medicaid, BCBS, Humana, Tricare, Aetna etc, to work on denied claims, to work on outstanding receivable dollar amounts, to work on ageing sheet, to work on ANSI batches (American national standard institute).