Company – Cft Healthcare
Position -Billing Specialist
Job Location – Pune
Working – Full Time, Hybrid 

We are seeking a skilled and experienced medical coder and biller with exceptional proficiency in conceptual writing and editing in English.

• The ideal candidate should hold a Bachelor of Science degree in Medical Coding, Billing, or a related field.
• Demonstrable experience in medical coding and billing.

Responsibilities:

1. Assigning Diagnostic and Procedural Codes: Reviewing medical records and assigning appropriate ICD (International Classification of Diseases) diagnosis codes and CPT (Current Procedural Terminology) procedure codes to patient encounters.

2. Ensuring Accuracy: Ensuring that all codes assigned accurately reflect the services provided, comply with coding guidelines and regulations, and support medical necessity.

3. Compliance: Staying up-to-date with coding guidelines, regulations, and payer policies (such as Medicare and Medicaid) to ensure compliance with legal and ethical standards.

4. Data Entry: Entering coded data into billing systems or electronic health records (EHRs) accurately and in a timely manner.

5. Claims Submission: Submitting claims to insurance companies or other third-party payers electronically or by paper, including reviewing claims for completeness and accuracy before submission.

6. Follow-Up: Following up on unpaid or denied claims, resolving billing discrepancies, and appealing denied claims when necessary.

7. Patient Billing: Generating patient statements, explaining charges and insurance benefits to patients, and assisting with payment arrangements or financial counseling.

8. Documentation Review: Collaborating with healthcare providers and other staff to ensure accurate and complete documentation to support coding and billing processes.

9. Quality Assurance: Participating in coding audits and quality assurance activities to identify and address coding errors, compliance issues, and opportunities for improvement.

10. Education and Training: Staying informed about changes in coding regulations and best practices through continuing education, seminars, and professional development activities. Additionally, providing education and training to healthcare providers and staff on coding-related topics.

11. Confidentiality: Maintaining patient confidentiality and adhering to HIPAA (Health Insurance Portability and Accountability Act) regulations when handling sensitive patient information.

12. Customer Service: Providing excellent customer service to patients, insurance companies, and other stakeholders by addressing inquiries, resolving billing issues, and ensuring a positive patient experience.

These responsibilities require a combination of technical coding knowledge, attention to detail, adherence to regulations, communication skills, and the ability to work effectively in a healthcare team environment.

Company – Cft Healthcare
Position – Medical Claim Collection specialists
Job Location – Pune || Working – Full Time, Hybrid 

Responsibilities

1. Claim Submission: Prepare and submit medical claims to insurance companies, ensuring accuracy and compliance with regulations and policies.

2. Follow-Up: Monitor and track outstanding claims, following up with insurance companies, patients, or healthcare providers to resolve issues and expedite payment.

3. Denial Management: Investigate and appeal denied claims, identifying reasons for denials and taking corrective actions to resubmit or rectify claims.

4. Payment Posting: Accurately post payments received from insurance companies or patients to appropriate accounts, reconciling discrepancies as needed.

5. Billing Inquiries: Respond to billing inquiries from patients, insurance companies, or healthcare providers, providing detailed explanations and resolving disputes promptly.

6. Documentation: Maintain detailed records of claim submissions, follow-up activities, payments, and communications for auditing and reporting purposes.

7. Compliance: Stay updated on medical billing and coding regulations, insurance guidelines, and industry trends to ensure compliance and maximize reimbursement.

8. Collections: Manage accounts receivable, including identifying and pursuing overdue payments, negotiating payment plans, and escalating collection efforts as necessary.

9. Reporting: Generate reports and analysis related to claim status, collection activities, aging accounts, and key performance indicators to evaluate effectiveness and identify areas for improvement.

10. Team Collaboration: Collaborate with other healthcare professionals, such as billing specialists, coders, providers, and administrative staff, to resolve complex billing issues and improve revenue cycle management processes.

11. Training: Provide training and support to new staff members or colleagues on billing procedures, claim processing, and compliance requirements.

12. Customer Service: Deliver exceptional customer service to patients, insurance companies, and internal stakeholders, addressing concerns professionally and ensuring a positive experience throughout the billing and collection process.

Company –  Cft Healthcare

Position -Account/Sales Representative
Experience – 2-4 years
Job Location – Pune
Working – Full Time, Hybrid 

Responsibilities:

1. Medical Billing Expertise:

   • Process medical billing claims accurately and efficiently using industry-standard software.
   • Review medical records and documentation to ensure compliance with coding and billing guidelines.
   • Verify patient insurance information and communicate with insurance companies to resolve billing issues.
   • Stay updated with healthcare regulations, coding changes, and insurance policies to ensure accurate billing practices.

2. Client Account Management:

   • Build and maintain strong relationships with healthcare providers, clinics, and hospitals.
   • Act as the primary point of contact for client inquiries regarding billing and reimbursement.
   • Address client concerns or complaints promptly and professionally, striving to maintain client satisfaction.
   • Collaborate with clients to optimize billing processes, identify areas for improvement, and implement solutions.

3. Sales and Business Development:

   • Identify and pursue opportunities to expand the client base by prospecting and generating leads.
   • Develop and present proposals to potential clients, highlighting the benefits of partnering with your billing services.
   • Negotiate contracts, pricing, and terms with clients while ensuring profitability and adherence to company policies.
   • Collaborate with the marketing team to create marketing materials and strategies targeting healthcare providers.

4. Data Analysis and Reporting:

   • Analyze billing data and financial reports to track revenue trends, identify discrepancies, and generate insights.
   • Prepare regular reports for clients, highlighting key performance indicators, revenue metrics, and actionable recommendations.
   • Use data-driven insights to advise clients on revenue optimization strategies and revenue cycle management best practices.

5. Compliance and Ethics:

   • Adhere to ethical standards and legal requirements related to healthcare billing, patient privacy (HIPAA), and fraud prevention.
   • Ensure all billing practices are compliant with relevant regulatory guidelines and industry standards.
   • Conduct regular audits and quality checks to maintain accuracy, integrity, and transparency in billing processes.

6. Continuous Learning and Professional Development:

   • Stay abreast of industry trends, technological advancements, and best practices in medical billing and revenue cycle management.
   • Pursue relevant certifications or training programs to enhance your skills and knowledge in healthcare billing and sales.
   • Share knowledge and insights with colleagues, contributing to a culture of continuous learning and improvement within the organization.