SME - Denial Management Zapare Technologies

2.0 - 3.0 years

4 - 5 Lacs

Kochi, Ernakulam, Thrissur

Work from Office

Designation: SME - Denial Management Experience: 2-3 years Skills desired: Detailed knowledge of US healthcare billing cycle Experience working with different EMR/EHR systems like Epic, Cerner, Allscripts, Athenahealth, NextGen, eClinicalWorks, Meditech, etc. Denial analysis and management - Review and analyze denied insurance claims to identify cause of denials such as coding issues, preauthorization, payer-specific policies - Develop and track denial log to monitor patterns and trends in denied claims - Experience talking with payers to obtain clarification with denials and initiate timely appeals when appropriate Expertise in working with denial reason codes (CARC, RARC) and identifying root causes of denials. Strong understanding of billing regulations, CPT, ICD-10, HCPCS codes, and compliance standards (HIPAA, CMS guidelines). Appeals - - Understand 1st, 2nd, 3rd, and External Level Appeal process, system, and documentation SOP - Prepare, submit, and follow up on appeals ensuring all necessary documentation is included - Revie Review assigned denials and EOBs for appeal filing information. Gather any missing information - Review case history, payer history, and state requirements to determine appeal strategy - Obtain patient and/or physician consent and medical records when required by the insurance plan or state - Gather and fill out all special appeal or review forms - Create appeal letters, attach the materials referenced in the letter, and mail them Maintain a record of all appeals and responses to track appeal outcomes and recovery rates Monitor payer response timelines to ensure appeal filing deadlines are met Track insurance company and state requirements and denial trend changes

Posted 2 weeks ago

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AR Caller(Expertise in ECW software) Qanat Consulting Services Private Limited

2.0 - 6.0 years

0 Lacs

karnataka

On-site

As an AR Caller at our office in Bangalore, you will have the exciting opportunity to utilize your expertise in eClinicalWorks (ECW) software and contribute to the growth of your career in medical billing and revenue cycle management. Your primary responsibility will be to make outbound calls to insurance companies, verify claims, and effectively resolve outstanding balances. Additionally, you will handle denials and rejections, ensuring timely corrections and resubmissions through the use of eClinicalWorks (ECW) software. It will be crucial for you to follow up on unpaid claims, escalate issues when necessary, and ensure prompt collections while maintaining accurate records of claim status, follow-ups, and resolutions. You will also play a key role in identifying trends in claim denials and suggesting process improvements to enhance efficiency and productivity. To excel in this role, you should have a minimum of 2 years of experience in AR calling and demonstrate proficiency in eClinicalWorks (ECW) software. A strong understanding of insurance guidelines, denial management, and appeals process is essential, along with excellent communication and problem-solving skills. Willingness to work night shifts in the US healthcare process and the ability to thrive in a fast-paced office environment are also key requirements. In return, we offer a competitive salary of up to 60,000 based on experience, along with ample opportunities for growth within our leading healthcare RCM team. You will have the chance to work in a dynamic and supportive office environment where your contributions are valued. If you are ready to take the next step in your career and seize this opportunity to grow in the healthcare industry, we invite you to apply now through our website www.qanatcs.in or contact us at +91 9908460566 / 9642049915 or via email at contactus@qanatcs.in / leadhr@qanatcs.in. Join us and be part of a team that is making a difference in healthcare.,

Posted 2 weeks ago

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