Pranay Shah

Job Summary: As a Subject Matter Expert (SME) in Medical Billing Industry we play a pivotal role in providing advanced expertise in medical billing processes, compliance, and industry regulations. You will be responsible for ensuring that our billing services meet the highest standards of accuracy, efficiency, and compliance.

Key Responsibilities:

1. Medical Billing Expertise:

• Serve as primary resource for in-depth knowledge of medical billing procedures, coding guidelines, and regulatory compliance.
• Stay abreast of evolving industry trends, changes in healthcare policies, and reimbursement methodologies.

2. Process Optimization:

• Collaborate with cross-functional teams to analyze and improve billing processes, identify bottlenecks, and implement solutions for enhanced efficiency and accuracy.

3. Compliance and Quality Assurance:

• Conduct regular audits of billing processes to ensure compliance with industry regulations, including but not limited to HIPAA, ICD-10, CPT, and other relevant standards.
• Develop and implement corrective action plans as needed.

4. Training and Development:

• Provide comprehensive training to billing teams, ensuring everyone have strong understanding of billing guidelines, coding updates, and compliance requirements.
• Act as mentor and resource for junior team members, offering guidance on complex billing scenarios.

5. Documentation and Reporting:

• Generate detailed reports on billing performance, including key performance indicators (KPIs) and compliance metrics.
• Prepare and present findings to internal stakeholders and clients as needed.

6. Client Consultation:

• Act as liaison between company and clients, offering expert advice on billing strategies, compliance issues, and revenue optimization.

7. Continuous Learning and Development:

• Keep abreast of emerging technologies, best practices, and industry developments related to medical billing.

1. Claims Processing and Follow-Up:

• Review and process insurance claims for accuracy.
• Rectify billing errors or discrepancies.
• Monitor pending claims for timely payment.

2. Denial Management:

• Investigate and resolve claim denials promptly.
• Collaborate with payers for proper reimbursement.

3. Aging Report Analysis:

• Regularly review accounts receivable aging reports.
• Prioritize and address aged claims for faster collections.

4. Insurance Verification:

• Verify patient insurance eligibility and benefits.
• Ensure accurate billing based on verified information.

5. Evaluating Team Performance:

• Discussing Team Performance with Team Lead in regards to Team Production and Quality.
• Sharing feedback to respective associates and weekly audit reports.