Reconcilliation Analyst

Detailed analysis of trends and patterns ofrejection during the reconciliation process through evaluation ofclaims; generation, tallying and maintenance of reconciliationreports for the departments and external and internal communicationof the recon data and queries. Overall taking measures to optimizerejection rate and meet individual and departmentalKPIs.

PrimaryResponsibilities:

·Taking measures to optimize the overall rejection rate for aprovider-payer account to below 5%

·Reconciliation of legacy claims with newly contracted clients, therecovered amounts should be based on the assessment of the claimsand rejection percentage to be maximum of25%

· Detailed evaluation of claims,retrospective audit of claims to bifurcate recoverable andnon-recoverable values with 100% accuracy on the grounds ofPayer-Provider agreement and RegulatoryAuthority-Coding-Documentation-Auditing guidelines for negotiationwith payers.

· Solely responsible forverifying claims ready for recon upload, performing the exercise ofupload of claims and compiling data.

·Generation and maintenance of reports for reconciliation, preparereconciliation summary, the claim wise & activity wisereport as per ACCUMED RECON format, to be updatedmonthly

· External: Communicating thenecessary and required data accurately (figures, claim analysis,signoffs etc) between payers and provider as perTAT

· Addressing challenges facedduring reconciliation to the concerned party;Resubmission/IRM/Client/CRM etc in order to avoid future grievancesand take corrective measures