Job description
Claims Processing and Revenue Cycle Management:
- Oversee the end-to-end claims processing and revenue cycle management process, including claim submission, follow-up, denial management, and payment posting.
- Monitor claim status, aging reports, and accounts receivable (AR) metrics to identify trends, patterns, and areas for improvement in the revenue cycle.
Denial Management and Appeals:
- Lead efforts to analyse claim denials, rejections, and underpayments, identifying root causes and implementing corrective actions to prevent future occurrences.
- Develop and execute appeals strategies to challenge and overturn denied or underpaid claims, ensuring maximum reimbursement for services rendered.
AR Team Leadership:
- Provide leadership, guidance, and mentorship to a team of AR analysts, ensuring productivity, accuracy, and adherence to best practices in medical billing and claims resolution.
- Conduct regular performance evaluations, provide constructive feedback, and facilitate training and professional development opportunities for team members.
Payer Contract Analysis:
- Review payer contracts, fee schedules, and reimbursement policies to ensure alignment with negotiated terms and optimize revenue capture.
- Identify discrepancies or discrepancies in payment amounts, fee schedules, or contractual obligations, and collaborate with payer representatives to resolve issues.
Performance Metrics and Reporting:
- Develop and maintain key performance indicators (KPIs) and performance metrics to track AR performance, productivity, and outcomes.
- Generate regular reports and dashboards summarizing AR metrics, trends, and performance against targets for management review and decision-making.