Accounts Receivable Caller-us Healthcare-thryve Digital Health Llp
- Thryve Digital
- 3 - 5 years
- Chennai
- 6 days ago
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Job Description
Role Summary:
The Senior Authorization/Pre-Estimate Collection Agent is responsible for securing required authorizations and pre-estimates for healthcare services prior to service delivery and ensuring the collection of patient financial responsibilities related to those pre-estimates. This role requires in-depth knowledge of insurance verification, authorization processes, pre-estimate calculation, and patient communication strategies. The Senior Agent handles complex cases, provides guidance to junior team members, and plays a key role in optimizing upfront collections and minimizing denials.
Essential Duties and Responsibilities:
Authorization Management:
- Verify patient insurance coverage and benefits to determine authorization requirements for planned services.
- Obtain necessary authorizations from insurance payers in a timely manner, using online portals, phone calls, and other methods.
- Document all authorization activities accurately and thoroughly in the billing system.
- Follow up on pending authorization requests and resolve any issues or delays.
- Communicate authorization status to patients, providers, and other relevant parties.
- Appeal authorization denials and follow up on pending appeals.
- Stay current on changes in payer authorization policies and procedures.
Pre-Estimate Collection:
- Calculate accurate patient out-of-pocket expenses (co-pays, deductibles, co-insurance) based on insurance benefits and planned services.
- Communicate pre-estimate information to patients in a clear and understandable manner.
- Collect patient financial responsibility (or establish payment plans) prior to service delivery.
- Document all pre-estimate and collection activities accurately in the billing system.
- Address patient questions and concerns regarding pre-estimates and payment options.
- Reconcile pre-collected amounts with actual charges after service delivery.
- Work with billing and collections teams to resolve any discrepancies.
- Understanding of HIPAA regulations and ensure compliance in all activities.
- Stay current on changes in payer regulations, coding guidelines, and billing requirements
Problem Solving and Analysis:
- Identify trends in authorization denials or pre-estimate collection challenges and propose solutions.
- Work with other departments (e.g., scheduling, registration, billing) to improve pre-service processes.
- Research and resolve complex authorization or pre-estimate inquiries from patients and insurance companies.
Mentorship and Training:
- Serve as a mentor and resource for junior Authorization/Pre-Estimate Collection Agents.
- Assist in training new team members on authorization procedures, pre-estimate calculation, and collection techniques.
- Provide guidance on handling difficult or complex cases.
Reporting and Process Improvement:
- Prepare regular reports on authorization rates, pre-estimate collection rates, and key performance indicators (KPIs).
- Identify opportunities to improve pre-service processes and increase efficiency.
- Participate in team meetings and contribute to process improvement initiatives.
System Proficiency:
- Utilize billing software, insurance verification systems, and other relevant tools to manage authorizations and pre-estimates (e.g., EPIC, Availity, etc.).
- Maintain accurate and up-to-date information in all systems.
Qualifications, Experience & Skills:
- Undergraduate degree or equivalent required; associate or bachelors degree in a related field preferred.
- Minimum of 5-7 years of experience in Patient Access, medical authorization, Prior Auth and/or pre-estimate collection.
- Proven track record of successfully obtaining authorizations and collecting patient financial responsibility upfront.
- Experience working with various insurance payers (e.g., Medicare, Medicaid, Commercial).
- In-depth knowledge of insurance verification and authorization processes.
- Strong understanding of medical billing
- Excellent communication and interpersonal skills, especially in explaining financial information to patients.
- Strong analytical and problem-solving abilities.
- Proficiency in using billing software and Microsoft Office Suite.
- Ability to work independently and as part of a team.
- Excellent organizational and time-management skills.
- Ability to handle a high volume of cases and meet deadlines.
Preferred Qualifications:
- Experience with EPIC preferred but not mandatory.
- Both Hospital and Professional billing experience preferred
- Flexible to work from Office all 5 days in the week
Job Classification
Industry: Medical Services / HospitalFunctional Area / Department: Healthcare & Life SciencesRole Category: Health InformaticsRole: Medical Biller / CoderEmployement Type: Full timeContact Details:
Company: Thryve DigitalLocation(s): Chennai
Keyskills: AR Calling US Healthcare Denial Management
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