Other Service Line BPO TeamLead Operations OPTLOP

title : BPO PE VOICE summary : In this role the successful candidate should have thorough working knowledge on resolving hospital claims inclusive of AR follow up and overcoming denials. This position will be responsible for working and resolving aged hospital account receivables. Candidate should be able to identify denial trends analyze the root cause of the hospital payer denials also should be familiar with technical payer policies appeal documentation and resolution. : 1to3Yrs Skills : MS Excel to have skills : : -Not Applicable : Day : Working knowledge of various RARC and CARC codes and how to work denials to resolution for reimbursement. Demonstrates knowledge and expertise in state/federal billing guidelines reimbursement methodologies and payer policies. Tracks and trends claim denials and underpayments to identify initiatives for payer process or technology improvement plans. Understanding of the RCM cycle and healthcare reimbursement processes Knowledge of Medicare Medicaid Managed Care and Commercial payor processes Exceptional problem solving and critical thinking skills to root cause denials and resolve accounts. Must meet quality and productivity standards. Demonstrates knowledge and expertise in state/federal billing guidelines reimbursement methodologies and payer policies. Makes recommendations for additions/revisions/deletions to work queues and claim edits to improve efficiency to reduce denials and underpayments. Identifies patterns and escalates to management as appropriate with sufficient information for additional follow up and or root cause resolution. Exceptional Excel skills to summarize and provide detailed reporting to management and client. Tracks and trends claim denials and underpayments to identify initiatives for payer process or technology improvement plans. Strong communication skills both verbal and written to ensure all actions taken are documented appeal letters are effective and root cause is communicated. Examine denied and underpaid claims to determine the reason for discrepancies. Communicate directly with payers to follow up on outstanding claims file technical appeals resolve payment variances and ensure timely reimbursement. Ability to identify with specific reason underpayments denials and cause of payment delay. Works with management to identify trend and address the root causes of issues in the A/R. Maintain a thorough understanding of federal and state regulations as well as payer-specific requirements and take appropriate action accordingly. Document activity accurately including contact names addresses phone numbers and other pertinent information. Demonstrate initiative and resourcefulness by making recommendations and communicating trends and issues to management. Needs to be a strong problem solver and critical thinker to resolve accounts. Must meet productivity and quality standards. Location : Primary :USNJPRIA01 Princeton - NJ USA COG Alternate : Type : 85CW00 Business Associate Requires Travel : N Required : None Model : Work from Home Contractor allowed : Y Project Code :