Account Receivable Officer at Tranquil & Quest Medical and Diagnostics Limited

Job Overview:

• The Account Receivable Officer is responsible for managing and ensuring accurate and timely collection of payments from patients, insurance companies, and third-party payors. This role involves monitoring accounts, addressing discrepancies, and ensuring compliance with billing regulations. The ideal candidate will demonstrate strong attention to detail, excellent communication skills, and a thorough understanding of claims processing and reimbursement procedures.

Key Responsibilities:

• Ensure accurate and complete follow-up on accounts by understanding carrier-specific reimbursement processes, including eligibility discrepancies, claims form preparation (1500/UB04), DRG, per diem, and case rate reimbursements.
• Contact government agencies, third-party payors, and patients/guarantors via phone, email, or online to resolve outstanding account balances.
• Document all follow-up activity and communications in patient account notes.
• Ensure proper posting of payments and adjustments; identify accounts for secondary billing and follow-up.
• Research and review accounts for balance accuracy, correct payor billing, coding accuracy, denials, and outstanding insurance requests.
• Provide necessary documentation, submit corrections, or escalate payor errors for re-processing.
• Request additional information from patients and payors as needed.
• Review payor contracts to determine expected reimbursements, identify underpayments, and draft payor demand letters.
• Identify billing or coding issues and request re-bills, secondary billing, or corrected bills as necessary.
• Track payor issues and trends, escalating them to management as appropriate.
• Ensure compliance with State and Federal Laws and regulations for managed care and other third-party payors.
• Perform other follow-up and administrative duties as requested by management.

Qualifications & Skills:

• Bachelor’s degree in Accounting, Finance, Business Administration, or related field.
• Proven experience in accounts receivable, billing, or claims processing (healthcare industry experience preferred).
• Knowledge of insurance claim forms (1500, UB04), coding, and reimbursement processes.
• Strong analytical, problem-solving, and organizational skills.
• Excellent written and verbal communication skills.
• Proficiency in Microsoft Office Suite and accounting software.
• Must possess strong knowledge and practical experience in Insurance.