Vector Outsourcing Solutions Philippines

• Work closely with Operations in collecting crucial data produced by the staff • Create reports and analyze data for Management's use • Together with the Report Writing team, explore and develop other methods to improve staff's/operations' performance • Maintain monthly reports of Management related to performance/manpower • Help out in other data-related tasks from Management

• Supervise and lead a team of medical billing specialists, providing guidance, training, and support as needed • Communicate and facilitate special projects, reports, and requests from client • Assign tasks, set priorities, and monitor performance to ensure productivity and accuracy • Develop and improve billing policies, procedures, and workflows to optimize efficiency • Review and approve billing documents, ensuring compliance with coding guidelines and regulatory standards • Manage accounts receivable, tracking outstanding balances and initiating collection efforts when necessary • Analyze trends and make recommendations to the client • Stay current with healthcare billing regulations, coding updates, and industry trends

• Ensure the preparation of accurate and compliant medical insurance claims for timely submission • Oversee the submission of claims to insurance companies, ensuring adherence to deadlines • Address claim denials by coordinating resubmissions and crafting detailed appeal letters • Develop and implement proactive strategies to minimize claim denials • Stay updated on the latest billing requirements, guidelines, and regulations • Adapt billing practices to ensure compliance with industry standards • Follow all client and team policies, procedures, and guidelines

• Track and manage accounts receivable, ensuring aging amounts remain within targeted levels. • Regularly check the status of submitted claims to ensure timely processing and payment. • Resubmit claims for appeal as necessary, working to resolve any issues that may delay payment. • Prepare and send out patient statements in a timely and accurate manner. • Conduct patient collection phone calls, professionally addressing outstanding balances and negotiating payment arrangements. • Respond to patient and payer's email and phone inquiries regarding their accounts, providing clear and helpful information. • Accept phone payments from patients, ensuring accurate processing and record-keeping. • Monitor Denial Trends and provide timely and accurate resolutions. • Handle complex denials and appeals. • Utilize different collection strategies to achieve optimum reimbursement on delinquent accounts. • Follow team and/or clients proper procedures, policies, and methodologies as instructed. • Performs other related duties as necessary or assigned.

• Conduct routine and random audits of healthcare billing transactions including charges, payments, claims follow-up, denials, and AR activities • Review daily, weekly, and monthly productivity reports of billing associates • Validate logged production against actual completed work • Investigate quota discrepancies, overstatements, duplicate entries, or unsupported outputs • Monitor AR aging inventory and collector activity • Audit follow-up actions for unpaid, denied, underpaid, or pending claims • Ensure adherence to client SOPs, HIPAA standards, internal controls, and company policies • Monitor completion of required trackers, checklists, and month-end deliverables • Support implementation of new controls, metrics, and process enhancements • Prepare QA scorecards, performance dashboards, and error trend analysis • Present findings to Team Leads, Supervisors, and Management • Provide structured feedback to employees and leaders based on audit results

• Submitting medical claims to the proper clearinghouse for the insurance payers to review and make the proper decision and payments • Processing & monitoring of all claim reports & electronic documents. (Electronic and Paper Claim Transactions) • Logging in and tracking all submission and rejection information • Responsible for obtaining edit reports and repair claims for re submission, test, and ensure repairs are made in a timely manner • Make sure that the claim was sent to the proper clearinghouse • Backup the EDI claim submission and logging of information • Keeps an update of Policy, Regulations and Payer/Clearinghouse changes • Coordinating & testing all Electronic Data Interchange (EDI) implementations with new EDI partners & current clearinghouse • Coordinate and work with clearing houses or trading partners to resolve EDI issues such as rejection and submission errors • Collaborate with payers, clearinghouses and/or trading partners to successfully maintain the EDI processes • Test, implement and document all processes required by the new accounts or new billing software • Reviews, analyzes and coordinates implementation for service modifications by EDI ( new payer ID, claim edits) • Monitors daily EDI performance, analyzes complex datasets, and troubleshoots issues and resolve them in a timely manner • Facilitates the successful on-boarding of new Clients EDI accounts • Assure interfaces (ECPP, QRSP, and HPNA) are performing as designed • Assure data integrity (correct files/batches are uploaded) • Manage the resolution process as needed (Coordination with Team, Leaders, account Manager) • Escalate EDI issues to Manager/ Credentialing if unable to resolve in a timely manner • Manage Send/Receive Files, Work Rejected claim (daily) • Random Claim Status inquiry • Claim File Reconciliation (batch received by charges and batch submitted by EDI) • Analyze Rejection and detection of error patterns that need correction on the billing end

• Collect outstanding balances from insurance companies • Investigate and resolve denied or underpaid claims • Submit appeals and reconsideration requests for denied claims • Review Explanation of Benefits (EOBs) and identify discrepancies • Communicate with insurance companies and dental offices regarding account status • Identify denial/ rejection patterns and implement corrective policy for future prevention • Accurately document all collection efforts, payment arrangements, and disputes

• Move demographic and scheduling information from one system to another • Check insurance eligibility thru websites or calls • Obtain dental procedure history • Accurately encode Fee Schedules in our practice softwares • Check accuracy of previously entered data • Collaborate effectively with other members of the Dental Team to ensure smooth operations

• Learn new systems of clients and effectively transfer knowledge to subordinates • Lead designated team, ensuring accurate and timely submission of deliverables • Coach subordinates and develop their skills • Assist Supervisor/Assistant Manager/Manager in directing the team towards the company's goals • Ensures compliance with company guidelines and procedures • Addressing any conflicts within the team that may arise • Create accurate medical insurance claims and ensure timely submission • Rectify claim denials with resubmission or appeals • Formulate and execute strategies to mitigate claim denials • Learn and implement specialty, state, carrier specific billing requirements

• Manage incoming calls from patients, healthcare customers, and service providers • Deliver accurate information and support regarding healthcare policies and procedures. • Address patient concerns, resolve issues, and follow up to ensure a satisfactory outcome. • Maintain thorough documentation of customer interactions and transactions. • Adhere to HIPAA and other relevant healthcare regulations. • Coordinate with other departments to escalate and resolve complex matters efficiently.