Process Associate

Key Responsibilities :-

Follow up with US insurance companies regarding outstanding and unpaid claims.

• Contact insurance payers through phone and online portals to check claim status.
• Analyze EOBs, ERAs, claim status, denials, rejections, and underpayments.
• Identify the reason for claim denials and take appropriate action for resolution.
• Work on AR aging and prioritize claims based on aging and outstanding balances.
• Submit corrected claims, reconsiderations, appeals, and required documentation when applicable.
• Verify patient eligibility and insurance benefits when required.
• Document all payer conversations and claim updates accurately in the billing system.
• Maintain detailed follow-up notes, including reference numbers, call dates, payer responses, and next follow-up dates.
• Coordinate with the billing, coding, and payment posting teams to resolve claim issues.
• Escalate complex claims and payer-related issues to the appropriate team.
• Meet daily productivity, quality, and collection targets.
• Ensure compliance with HIPAA and company policies while handling patient information.
• Required SkillsGood understanding of the US Healthcare Revenue Cycle Management (RCM) process.
• Knowledge of AR Follow-Up, Denial Management, and Claims Processing.
• Familiarity with Medicare, Medicaid, Commercial, and Managed Care payers.
• Knowledge of common US insurance portals such as Availity and payer-specific portals is preferred.
• Good knowledge of EOB, ERA, CPT, ICD-10, claim forms, denial codes, and payer remark codes.
• Excellent verbal and written communication skills.
• Good analytical and problem-solving abilities.
• Ability to handle payer calls professionally and confidently.
• Good typing and computer skills.
• Ability to work independently as well as in a team.