Objectives of this role
Responsibilities
- Authorization Submission: Initiate and follow up on prior authorization requests with insurance payers via phone, fax, or online portals.
- Documentation Review: Review clinical notes, medical records, and physician orders to ensure they meet insurance medical necessity criteria.
- Communication: Act as a liaison between physicians, clinics, and insurance companies to obtain additional information and communicate approval/denial status.
- Insurance Verification: Verify patient benefits and ensure accurate ICD-10 (diagnosis) and CPT (procedure) codes are utilized for submissions.
- Denial Management: Initiate appeals for denied claims and track authorization status through completion.
Verify coverage and eligibility for medical services
Communicate with insurance providers and patients
Review patient bills and correct any missing or inaccurate information
Use a billing software to prepare and transmit claims
Clear up balance discrepancies
Investigate and appeal claims that were denied
Complete data entry to update spreadsheets and reports
Work with patients to set up payment plans
Adapt to updates and changes in billing software
Process denial management for claims rejected by the Insurance companies
Required skills and qualifications
- 3-5 years of experience as a Prior Authorization and Medical Biller
- Experience should include the understanding and usage EHRs/EMRs
- Technical Skills: Microsoft Office Suites, Microsoft365, Typing
- Reporting. Organizational and Record-keeping skills
- Solid oral and written communication skills
- This role is in Hyderabad, India (HITECH City) and the candidate must be able to work from the office.
- Knowledge of unfair debt collection practices and insurance guidelines
- Understanding of primary code classifications: ICD-10-CM, ICD-10-PCS, CPT and HCPCS
- Communication skills with patients/healthcare companies
- Basic accounting and bookkeeping practices
- Passion for healthcare and technology
- Strong customer relationship management skills
- Ability to foster strong, positive relationships
- Proven ability to set goals and meet deadlines
- Understanding of healthcare billings industry
- Credentialling experience (plus)
Education, Experience, and Licensing Requirements:
- Bachelor's or Associate's degree preferred
- Familiarity with ICD-X codes and CPT Procedures
- Skilled in operating various medical record software and hardware, word-
- processing, and database software programs
- Coding Certification is a plus
Pay: ₹400,000.00 per year
Work Location: In person
