Roles & Responsibilities in Miramed Ajuba.Reviewing the work performed by AR Analysts and documenting any quality issues.Reviewing call quality issues on various parameters such as conversational skills, claims resolution, and voice quality.Conduction Daily QAT & Fact Sessions in the presence of TL's & sharing the MOM on the very same day.Sharing Daily Audit Report & Closing(Rebuttals, if any) on the Very same day.Attend Every Client Call & Cascade all New updates to the Team.Providing feedback and working with the training team to provide remedial training.Being in the center of ethical behavior and never on the sidelines.Identifying process gaps by analyzing Weekly Audit reports & based on parameter & Scenarios help Associates to hit numbers along with Quality.Excellent team motivator & Compliant with rules and regulations.Coordinating with clients and closing open issues, where if Agent comes up with the new Scenarios within Process or from Payors.

Roles & Responsibilities in Gebbs.Reviewing the work performed by AR Analysts and documenting any quality issues.Reviewing call quality issues on various parameters such as conversational skills, claims resolution, and voice quality.Conduction Daily QAT & Fact Sessions in the presence of TL's & sharing the MOM on the very same day.Sharing Daily Audit Report & Closing(Rebuttals, if any) on the Very same day.Attend Every Client Call & Cascade all New updates to the Team.Providing feedback and working with the training team to provide remedial training.Being in the center of ethical behavior and never on the sidelines.Identifying process gaps by analyzing Weekly Audit reports & based on parameter & Scenarios help Associates to hit numbers along with Quality.Excellent team motivator & Compliant with rules and regulations.Coordinating with clients and closing open issues, where if Agent comes up with the new Scenarios within Process or from Payors.

Denial Management, Claims & Appeals Follow-up & Preparing Appeals) • Call insurance companies on behalf of hospitals or facilities and further examine outstanding Accounts Receivables. • Prioritizing unpaid claims for calling according to the length of time it has been outstanding. • Calling insurance companies directly and convincing them to pay the outstanding claims. • Checking the relevance of insurance info offered by the patient. • Evaluating unpaid insurance claims. • Calling insurance companies and checking on the status of claims• Transferring the outstanding balance to the patient if he/she doesn’t have adequate insurance coverage. • If the claim has already been paid, ask the insurance company for Explanation of Benefits (EOB) for payment posting. • Making necessary corrections to the claim based on inputs from the insurance company.• Analysing Claims that are processed & applied towards Offset & recoupment & if in Timeframe, Calling & sending Claims back for review.• Analysing Claims if adjustments were Taken Correctly or Posted Incorrectly.• Following up on 1st & 2nd Lvl Appeals.• Utilize DDE(Direct Data Entry) in case of Medicare makes any Necessary Correction & Press F8 to send claim for reprocessing as Medicare Doesn’t accept Corrected Claims Only In case of Added Charges. PREPARING APPEALS, FAXING & PLACING IN CLIENT FOLDER• Preparing Appeals with contract rates, Highlighting to the payor that they processed the claim incorrectly as per Contract we should get paid Expected amt.• Preparing Appeals if Payor is Asking for Complete MR or Emergency Records, or Test Results or doctor notes depends on Scenario which Payor is Denying a claim.• Preparing Appeals with POTFL if claims are denied as Past the Timely Filing limit.• Also Faxing the info which we need for claims or Appeals Status as Some Workers Comp or other payor wont provide over the Call.ETC

Work Experience, Sutherland:• Use to Review patient ledgers with outstanding charges and take next best action for follow up to collect balances• Always be watchful for any major rejections or denials.• Constantly watch out for payments and EOBs from major Carriers, pay-to-Address, Provider Numbers etc.• Ensure the AR days meet Industry Standards.• Use to Verify insurance eligibility and update patient accounts based on client-specific SOPs• Use to Investigate claims status and next best option for open accounts via available insurance websites• To investigate claims status, identify appeals action and next best action to resolve accounts• Identify claim denial trends or provider related issues that delay or reduce reimbursement.• Use to come across Pain management services(Injections) and E and M service Mostly.

Work Experience Harmony Medsolutions: AUTHORIZATION Roles & Responsibilites• Check patient eligibility and benefits with their insurance providers; i.e., Medicare, Medicare supplements, Medicare replacements, managed care, HMOs, PPOs, POS• Analyses insurance coverage and benefits for service to ensure timely reimbursement.• Obtains all prior authorizations as appropriate based on insurance plan contracts / guidelines• Authorize all routine and medical office visits, procedures, lab requests, injections, etc.• Authorize additional services required by physicians at the time of service• Authorize new patient coverage before scheduled appointment. • Adhere to all HIPAA rules and regulations at all times• Accurately and timely process requests• File correction action requests; i.e., expired date extensions, code corrections, specific doctor corrections, visit corrections• Process referrals and submit medical records to insurance carriers to expedite prior authorization processes• Sort medical records and submit them to the carrier in a bid to expedite the authorization process• Manage correspondence with insurance companies, physicians, specialists and patients as required• Always be watchful for any major rejections or denials.• Constantly watch out for payments and EOBs from major Carriers, pay-to-Address, Provider Numbers etc.• Use to Verify insurance eligibility and update patient accounts based on client-specific SOPs• Use to Investigate claims status and next best option for open accounts via available insurance websites (Authorization and Cpt Codes)• To investigate claims status, identify appeals action and next best action to resolve accounts (Authorization and Cpt Codes)

Work Experience, Hinduja Group:• Use to Review patient ledgers with outstanding charges and take next best action for follow up to collect balances• Always be watchful for any major rejections or denials.• Constantly watch out for payments and EOBs from major Carriers, pay-to-Address, Provider Numbers etc.• Ensure the AR days meet Industry Standards.• Use to Verify insurance eligibility and update patient accounts based on client-specific SOPs• Use to Investigate claims status and next best option for open accounts via available insurance websites• To investigate claims status, identify appeals action and next best action to resolve accounts• Identify claim denial trends or provider related issues that delay or reduce reimbursement.• Utilize DDE(Direct data Entry) in case of Medicare to make any Necessary Correction & Press F8 to send claim for reprocess as Medicare Doesn’t accept Corrected Claims Only In case of Added Charges.