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HR and Management Consultants

Job Code : JN/43037/2013
Function area : Revenue Cycle Management
Contact Person : Mahalakshmi
Industry type : Health Care
Position : Payer Specialist
Status : active
Hiring Role : Payer Specialist
Response Ph/Mob : 45110015-18
Response Email 1 : mahalakshmi@busisol.net
Date : 24-Mar-2018
End Date : 21-Apr-2018
Nationality : Indian
CTC Range : 8 lakhs
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Job description : Job Description – Payor Specialist Designation: Payor Specialist Department : RCM Reporting Structure: Manager Position Based Out of: Mumbai Working Hours: 24/7 (Primarily Night Shift) Website: www.eclinicalworks.com Job Description Purpose of the position: eClinicalworks seeks a Payor Specialist with specific expertise in driving cash collections for Healthcare providers from major national insurance payors such as Medicare, Medicaid, Blue Cross Blue Shield, United Healthcare, Aetna, Humana, and Cigna across all US States etc. The specialist will be primarily responsible for maximizing the collections for the identified payors through the identification and resolution of existing issues that are preventing maximum possible collections. Job Specifications · Evaluate current processes and procedures for payor and identifying issues that cause rejections, denials, 90+ AR build up then implement changes in the payor specific revenue cycles to optimize the rejections and denial rates leading to higher first pass collections for the payors · Prevention of Rejections and Denials by working with Client and Operations · Analyze and review AR for assigned payors and then work with Reimbursement and Operations teams resolve AR buildup in a timely manner. · Work with File Maintenance to update payor setup to improve first pass ratio. · Identify quick cash escalations / Global issues and resolve them with the Operations and Client to accelerate cash · Project cash every month for the payer for each client assigned · Project cash target for each payer by client for the year and achieve the cash target. · Identify cash shortfall for the Payor and lead cash recovery projects related to these payors for all the clients · Respond timely and set expectations to escalations from clients, Reimbursement and Operations teams to solve issues identified for payors. · Provide ADHOC reporting as and when needed. · Improve average net collected per visit for the Payor · Increase ERA’s with payors and work with File Maintenance to reduce rejections and map Denial, Remark Codes · Develop by medical specialty and geography ideal RCM models for the payors such that these models are reused every time eCW sets up a RCM team for those payors for that specialty in that geography. · For existing and new clients develop SOP’s, Best Practices, and Cheat Sheets in the areas of Billing and Collections on the specific nuances of each payor. · Work with the QA, Training Team to develop training materials and Quality Audits , along with reviewing and monitoring their performance to insure compliance to the processes established · Work with Reimbursement, Operations, QA and Training Team to develop best practices that reduce the number of touches and increases the Resolution rate to solve an account and bring cash quickly in to the door · Review current claim processing practices & establish the process flow as per desired payor practice to ensure minimum denials / rejections · Design, develop and implement proactive on the job training per payor aimed at refreshing payor specific practices as well as provide ongoing updates in case there are certain changes in payor specific process · Develop knowledge repositories and training material related to payor/plan best practices for different specialties from a Billing and Accounts Receivable collections perspective such that they can be reused when we have cash issues for different provider clients related to these payors/plans · Keep abreast of changes with payors and update Reimbursement and Operations and update the online rules engine so that the updates are shared across eCW. · Use the payor/plan knowledge in the initial transition as clients outsource their RCM function to eCW to reduce unclaimed monies. · Provide access points for the Reimbursement and Operations team to the provider websites · Attend client calls as needed to drive reimbursement through improved first pass ratio and special projects. · Research new specialties and the Payer specific rules for those specialties by region and Development of best practice model of RCM Operations for new specialties · Develop solutions for perspective client collections needs and also support the solutions teams in the pricing model · Attend Payor meeting and Healthcare seminars Job Requirements · At least 5 to 7 years of experience driving collections from the payors they are going to specialize in across national plans from those payors. · Strong experience and/or extensive training on major US Healthcare Insurance payor-specific billing and collections with clear understanding of payor specific rules and regulations · Demonstrated ability in driving industry benchmark collection rates from the payors they are responsible for RCM providers that originally were leaking cash from those payors · Demonstrated ability to work with large RCM Operations teams implementing payor specific RCM models in a sustainable manner · Strong attention to detail, along with the ability to analyze and understand large amounts of data · Strong personality to be able to push back in a polite manner but continue to focus on the goal · Excellent verbal and written communications skills · Strong analytical and quantitative skills. Should possess a strong reasoning capability based on logic and numbers. · Skills in process analysis, process mapping, process documentation · Should posses basic MS Office skills (MS Excel, MS Word, PPT and others, if any) · Ability to perform well under pressure, adapt to change, and meet deadlines in a fast-paced environment · Bachelor’s degree is preferred General Requirements · Excellent Communication Skills. · Should be an absolute go-getter willing to go the extra mile all the time. · Should be very process and data driven. · Candidates working in Medical Billing companies preferred. Education Candidate should be Graduate with 5+ years of experience in RCM and minimum 18 months are a Team Leader. Compensation As per company standards Shifts Night Shift (EST, CST, PST) (i.e. 6:00 PM to 6:00 AM IST) Perks/incentives if any None
Uploaded Date : 24-Mar-2018


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