inDeveloping a solid understanding of assigned client’s processes in order to strategically review and analyze their A/R functions • Conducting regular audits of representative claim work for accuracy and quality. • Providing direction to client leads on claim audit corrections and resolution. • Preparing and analyzing reports of audit review and performance issues with a focus on identifying trends, instituting continuous quality improvement initiatives, and identifying and providing ongoing training opportunities for representatives. • Providing second tier review on advanced and escalated claims issues to a satisfactory resolution. • Logging all client issues encountered in internal tracking system, including enhancement requests, bugs, errors, and inquiries. • Updates Craneware’s Medical Necessity Product by comparing application records with CMS database, payer websites and payer policies and billing/coding guidelines. • Weekly review of Commercial website policies to identify and maintain all clinical procedures requiring prior authorization. • Formats policy data into required formats (extraction of data into Craneware format). • Maintains a high level of integrity of data entered in tables in accordance with Standards of Operation Guidelines and Regulatory best practices. • Weekly utilizing the QA tool, review updates for accuracy of entry. • Weekly reporting of retired, revised and new policies by payer. • Collaborates with Senior Coder to review and analyze medical necessity policies to ensure accuracy of CPT/ICD-10 Dx coding combination. • Assists in reviewing and updating tables relating to CPT and ICD-10 Coding Rule Changes. • Researches New Payer requirements with resources required to maintain the payer particular emphasis on Prior Authorization and Medical Necessity policies.

Quality Control Audits: Routinely audits outsourcing company and in-house staff accounts by ensuring
• Follow up procedures are done timely in accordance with policy
• Actions taken were the correct and the most effective actions at that point in time
• Notes are properly entered and updated
• Correspondence is followed up properly and timely
• Reimbursements received is at the contracted rate.

Training: Coordinate training programs for staff/s (employees, contractors and outsourced staff) including:
• Develop written materials for training.
• Conduct periodic training sessions
• Stay abreast of new developments and changes in assigned carrier and communicate to other departments
• Provide documented specific instructions relating to new physician.
• Complete a quality control audit spreadsheet monthly for each outsourcing company as well as internal staff and independent contractors, either by complete QA or calibration.
• Sample over 120 days open accounts monthly to determine where problems are occurring and provide feedback to relevant departments

Coordinate Workflow: Direct workflow for follow up and correspondence between staff/s to ensure accounts are worked effectively and within policy time limits.
• Maintain monthly days in accounts receivable reports by database to track effectiveness of follow up by staff/s.
• Provide feedback on performance of staff/s.
• Work closely with staff/s in meeting and exceeding monthly accounts receivable goals.
• Responsible for keeping "shared folder" reports updated in timely manner (no less than three days behind).
• Maintain effective communication with Outsource Team Lead counterpart.
• Communicates all concerns and issues to Outsource Team Lead counterpart and resolves them in a timely manner.

• Work on Doctor’s AR according to their Carrier’s TFL and Buckets.
• To check patient‘s Insurance policy information using insurance web portals/ Live calls
• To ensure Quality of entered Data by confirming it by a soft call to Patient.
• Calling/Emailing the Doctor’s offices for the problem lists.
• To work on Rejections received.
• To collect information about the payments.
• To Fix the Rejected claims...
• To maintain quality and quantity of the work according to Client’s requirement.

Provided continual support to departments’ managers and ensure the employee welfare is maintained.
• Responsible for supervising customer service agents and other staff. Trains, coaches, and mentors employees on how to deliver the best customer service possible.
• Asked customers to provide feedback on agents and customer service experience.
• Handled major incidents that cannot be resolved by agents.
• Reviewed and planned departmental activities to ensure business value was driven.
• Provided leadership and training to newly hired executives and continued to facilitate service strategies.

Provided continual support to the employees on HR & Admin matters.
• Designed and implemented leadership programs.
• Developed and produced marketing/promotional materials to promote benefits of new products.
• Developed and implemented appropriate training and development of Customer Services Executives.
• Responsible for selecting countries to be covered.
• Worked closely with HR on new company acquisition integration for new employees.
• Conducted interviews with government officials and corporate leaders to kick start projects.
• Worked with the business leaders to support key business initiatives through training activities.

Performed all aspects of customer support, including answering telephones, coordinating special promotions, and providing details for products and services.
• Handled inbound sales duties, including order entry processing and fulfillment.
• Resolved billing questions and disputes, initiated customer calls, and performed data entry.
• Served customers by providing product and service information; resolving product and service problems.
• Resolved product or service problems by clarifying the customer's complaint.
• Answered participant questions, as well as question participants to obtain full understanding of what information is being requested.
• Interacted with customers extensively to maintain customer satisfaction.