Medusind Inc.

Compensation

Full Description

Description: Medusind is a leading provider of revenue cycle management solutions to medical, dental, behavioral health, anesthesia, pathology, emergency, surgery, radiology, and other specialties. In January 2023, Alpine Investors, a people-driven private equity firm, invested in Medusind to continue to advance its leadership position as one of the top revenue cycle management companies in the country. AR Team Lead is responsible to support the AR supervisor with claims follow-up, escalation, and troubleshooting activities related to the adjudication of all claims. This role is responsible for supporting a team and ensuring key performance indicators (KPIs) are met, including DSO, >120 AR, and reducing write-offs. The ideal candidate has strong problem-solving skills, expertise in AR follow-up strategies, and a hands-on approach to improving claims adjudication success. Key Responsibilities: • Phone Calls/meetings with customers • AR Follow-up- calls & portal Claims Management: • Update claims status-move claims to appropriate Dept • Escalated Claims Expertise and execution • Rekick claims Resubmissions (NOF) Investigation & Troubleshooting: • Investigate billing/contract issues • Investigate/confirm authorization details • Identify Underpayments (contract rate not met). Denials Management: • Investigate/Escalate/Reprocess denials • Draft/Submit Written Appeals (TFL, non-covered services) • Request Medical Records for appeal (med Rec Internal) • Confirm cashed check status -Check tracers, balance bank-box • Investigate/Resolve Contract issues notify CSM • Negotiate SCA Rates Cross Training/SOP needs refinement • Negotiate Front-End (Multiplan, GCS) & back end-low pay appeals • Provide 91+ reporting (Determine scope/frequency) • Research Specific Payer Issues and work with Payer Provider contacts • Aging 120 special focus- Detailed report + Action plans • Account Assignments & the "health" of that account • Write off recommendations - to give to CSMs Continuous Improvement: • Work with India leadership to ensure A/R functions being performed in India are meeting SLA's, quality, production, etc. Requirements: Educational Background: • Bachelor’s degree in data Analytics, Business, Finance, Healthcare Administration, or related field (preferred). Experience: • Behavioral Health RCM understands SUD/MH levels of care, and overall claims adjudication challenges. Strong understanding of AR follow-up strategies, payer reimbursement policies, and insurance claim adjudication processes. Expert Industry Knowledge: • Proficiency in revenue cycle management platforms, workflow automation tools, and data analytics for AR tracking. • Knowledge of HIPAA, Medicare, Medicaid, and payer regulations. Collaboration & Communication: • Ability to work independently and collaborate with cross-functional teams. Detail-Oriented: • High level of accuracy, with the ability to set and maintain priorities in a fast-paced environment.