The WorldSource Career

KEY RESPONSIBILITY AREAS (KRA):

• Effectively operate and manage locations in Muntinlupa and Iloilo, Philippines
• Create and review appropriate plans to manage target results, customer service, employee utilization, and budget expenditures
• Review the financial management of the organization including financial forecasting, budgeting, reporting
• Develops specific short-term and long-term plans and programs for each business area
• Coordinate and collaborate with all departments within the organization in establishing and implementing company operating policies
• Directs, monitors, and evaluates the performance of direct leaders of the organization
• Hire, train, coach and develop a team of managers and leaders focused on providing the best possible experience for clients and employees
• Develop, implement, and maintain effective Workforce Management (WFM) and Quality Assurance (QA) programs that drive continuous improvement and exceed Service Level Agreement (SLA) performance
• Work closely with global management team to develop new strategies to optimize existing resources and provide regular updates on any operational related issues
• Manage and adhere to local labor compliance rules. Understand and comply with policies and procedures
• Oversee all internal and external regulatory compliance
• Maintain close relationships with the team to ensure business success

GENERAL RESPONSIBILITIES:

• Ensures strict confidentiality of clients, patients, and financial records to comply with PHI, ePHI and HIPAA
• Review, acceptance, and understanding of workplace culture statement
• Responsible to comply with organization's policies and procedures, adhere to Code of Conduct
• Ensures to complete the required compliance training modules and report any observations of non-compliance
• Other duties that may be assigned

REQUIREMENTS AND SKILLS:

• 5+ years of senior leadership experience in a healthcare business management preferred BPO
• Experience in budget preparation and maintenance
• Proven track record of managing complex and highly technical projects across all functions and business units
• Demonstrated ability to analyze, develop, and implement metrics and improve processes to ensure key performance indicators align with desired outcomes
• Ability to develop key metrics, KPI’s, etc. as related to a BPO environmen
• Experience working in a global capacity
• Ability to travel between Muntinlupa and Iloilo as necessary
• Experience leading teams across multiple locations and time zone

JOB DESCRIPTION:

• Reports directly to the General Manager.
• Assists top and line management in achieving the company’s objective of fostering harmonious Relationship with its human resources.
• Oversees activities in selection and recruitment of competent people and provide them with opportunities for advancement and self-development.
• Formulating policies and programs that will serve the requirements of the company and administer the same fairly to all employees.
• Provide technical services such as but not limited to counseling and coaching, and assistance to the operating management in relation to their personnel functions in promoting satisfactory work environment.
• Formulate and implements the training and development system of the company to uplist its human resource competence and productivity
• Sees that all employees are treated equally and fairly in the application of company policies, rules and regulations and in services rendered to them.
• Helps effect organizational changes and development to achieve the company’s goal and objectives.
• Prepares departments budget (execution, midterm plans) and analyze actual results.
• Conceptualize and formulates cost savings measure for the department to support the company in achieving the IBT set by the corporate.
• Concurs request of payments, petty cash vouchers, and ensure that all financial transactions of HRAD are in accordance with the existing policies and procedures.
• Regularly coordinates with association related to HR functions, DOLE and other related government agencies to ensure the company’s activities are within legal boundaries.
• Regularly coordinates with the company
• s service providers likewise monitors and evaluate their performance.
• Oversees HRAD staffs activities including monitoring and evaluation of their performance.
• Regularly reports accomplishments, plans, and operating activities during Managers meeting.
• File necessary reports associated with HRAD administrative activities.
• Develops and Implements New Hire Orientation procedures and instructions, and assist in development and implementation of corporate training activities.
• Manages all company wide activities and corporate events
• Performs other tasks that may be assigned from time to time

Manila and Iloilo, Philippines

Key Responsibilities Areas (KRA):

• Take the data provided by the medical coders and use it to compile and submit claims to insurance companies and then subsequently bill patients
• Navigate through various insurance rules and regulations to reduce A/R days
• Understand the nuances of various types of insurance carriers along with their claim requirements
• Provide successful follow-up efforts for A/R including the appeals process for denied claims
• Implement best practices for insurance and patient collections while maintaining excellent public relations
• Reduce risk by understanding Fair Debt collection practices, professional courtesy regulations, clean claims and timely filing guidelines, refund requirements, and other regulations
• Use data and reports as indicators for potential improvement areas
• Collect delinquent accounts by establishing payment arrangements with patients, monitor payments and also follow-up with patients when/if payment lapses occur
• Maintain Medicare bad-debt cost report by tracking billings, monitoring collections, compiling information
• Initiate claims against estates by monitoring deaths and unpaid accounts
• Secure outstanding balance payments for care of hospital employees by establishing payroll deductions; obtaining signatures for automatic transfers
• Maintain work operations by following policies and procedures; reporting compliance issues
• Protect hospital value by keeping collection information confidential
• Adhere to professional standards, hospital policies and procedures, federal, state and local requirements
• All other tasks and duties as assigned

Qualifications:

• Must possess at least a Vocational Diploma / Short Course Certificate / Bachelor / College Degree, any field
• Must be willing to work in Iloilo City / Alabang site
• At least 1 year of working experience in the related field is an advantage
• Preferably 1 year experienced employee specializing in customer service or equivalent

Manila, Philippines

JOB DESCRIPTION :

The NOC Engineer will be supporting through remote connection and is responsible in:

• Troubleshooting Disk Errors, Services Not Running, Installing/Configuring Antivirus and Antimalware;
• Working with PCs and Servers Event Logs;
• Troubleshooting issues with Windows Updates and Microsoft Patches;
• Maintaining disk drives above threshold; and
• Other tasks to be assigned from time to time.

Job specifications :

• At least 1 year of working experience in related field is required for this position.
• Able to work from home temporary.
• Someone passionate about technology.
• Able to think quickly and act swiftly.
• Have a positive attitude.
• Basic expertise in hardware and software troubleshooting.
• Proficient in basic Microsoft products and softwares.

USA

JOB SUMMARY :

Oversees and/or performs all tasks related to medical billing for specific clients. Coordinates workflow and communication between the client and Pettigrew. Monitors offshore resources for productivity and quality assurance.

General Job Responsibilities :

• Addresses all new work AR within 3 days of receipt on average
• Works Clearinghouse rejections daily
• Works with WSI or WSP staff and management to maintain Days in AR at 45 days or less and that 90+ aging is 15% or less of total AR
• Reviews and resolves aged AR; (objective is to have no more than 5% in any bucket over 91 days); Provide reasoning for any buckets above this percentage
• Applies appropriate appeals process where needed
• Resolves denied claims timely; minimize TLE's; works with carriers on claim resolutions
• Ensures appeals process is being followed according to Pettigrew Policy
• Assists with EOM Process as needed.
• Communicates with clients and their staff on a daily basis to resolve issues or errors.
• Communicate to management any negative trends; if applicable
• Ensures strict confidentiality of patient and financial records to comply with PHI, ePHI and HIPAA
• Where applicable: releases claims daily and additionally when new providers are approved by carriers. For MicroMD clients, bills claim no less than every two days.
• Where applicable: Monitors eBridge to ensure work is being completed within 3 days of receipt.
• Manages credit balances and works with clients to refund patients.
• Review, acceptance, and understanding of our workplace culture statement.
• The responsibilities listed in this job description are general descriptions of work assigned, duties and responsibilities may not be limited to just these responsibilities.

Work Experience Requirements:

• Knowledge of Microsoft Office, Outlook, Google Suites, Data Entry skills; knowledge of paperless processes
• Ability to interact and communicate with people over the telephone, often in stressful situations
• Ability to communicate effectively, both orally and in writing
• Ability to gather data, compile information, and prepare reports
• Ability to use independent judgment and to manage and impart confidential information
• Records maintenance skills; both manual and scanned documents
• Knowledge of medical insurance claims procedures and documentation

Education Requirement(s):

• GED or high school diploma required; associate’s or bachelor’s degree preferred
• at least 3-5 years of business experience with an emphasis on the medical field; banking/financial institution experience a plus

USA

JOB SUMMARY :

Oversees and/or performs all tasks related to medical billing for specific clients. Coordinates work flow and communication between the client and Pettigrew. Monitors offshore resources for productivity and quality assurance.

General Job Responsibilities :

• Processes billings to third party carriers and patients; maintain supporting documentation files via online archive (scans)
• Use online tools to verify eligibility to ensure a “clean” claim
• Accesses client EMR to capture charges and payments if applicable; maintain ADT interface for clients if applicable.
• Keys data and/or uploads to offshore resources: manual and/or automated transactions and verifies accuracy of input by balancing to both charge and deposit reports on a daily basis
• Research and respond by telephone and in writing to client and patient inquiries regarding billing issues and problems within 24 business hours.
• Report credit balances on a monthly basis to the client; adjust balances once checks are issued and note accounts.
• Process patient payments over the phone utilizing PCI affiliated tools.
• Resolve clearinghouse rejections daily
• Manage accounts for turn over to a collection agency or adjust off to bad debt based on client preference.
• Communicates with clients and their staff on a daily basis to resolve issues or errors.
• Communicate to management any negative trends.
• Ensures strict confidentiality of patient and financial records to comply with PHI, ePHI and HIPAA
• All other tasks and duties as assigned
• Review, acceptance, and understanding of our workplace culture statement.
• The responsibilities listed in this job description are general descriptions of work assigned, duties and responsibilities may not be limited to just these responsibilities.

Work Experience Requirements:

• Knowledge of Microsoft Office, Outlook, Google Suites, Data Entry skills; knowledge of paperless processes
• Ability to interact and communicate with people over the telephone, often in stressful situations
• Ability to communicate effectively, both orally and in writing
• Ability to gather data, compile information, and prepare reports
• Ability to use independent judgment and to manage and impart confidential information
• Records maintenance skills; both manual and scanned documents
• Knowledge of medical insurance claims procedures and documentation

Education Requirement(s):

• GED or high school diploma required; associate’s or bachelor’s degree preferred
• at least 3-5 years of business experience with an emphasis on the medical field; banking/financial institution experience a plus

USA

JOB SUMMARY :

This position interacts directly with clients to assist them with application and participation with third party insurance carriers. Oversees all Credentialing and EDI Enrollments.

General Job Responsibilities :

Credentialing

• Manage all credentialing tasks
• Review all emails pertaining to Credentialing. Add to workload when necessary. Check that responses are being added to OneApp and Status reports. Answer questions that arise. Research when necessary.
• Contact providers or managers to obtain required information and signatures for applications
• Assign applications to be completed and reviewed for proper documentation
• Monitor initial request, submission time and follow up on each application. Redirect when needed
• Monitor all applications for approval.
• Review follow up notes and status report weekly and submit status to provider
• Call carriers with issues or guidance when needed
• Maintain OneApp for all client credentialing in order to document steps taken and time involved
• Respond to clients promptly and communicate timeline on specific carrier guidelines
• Work with team members to resolve credentialing questions and issues
• Work with carriers in all states and different MACS; research carrier requirements and applications for accurate submissions.
• Unlock provider’s Pecos accounts when needed
• Complete and submit all Pecos enrollments
• Monitor all Pecos enrollments for provider signatures
• Check Pecos status weekly, troubleshoot any problems or delays
• Review OneApp and PI periodically and follow-up with staff to update or add notes as needed
• Address changes – update files in software so that claims, statements, appeals and letters all go out with correct address
• Train staff when necessary
• Interview and work closely with HR for staffing purposes

EDI

• Review all email pertaining to Claim Submission, ERA and EFT
• Queue enrollments and notify team when necessary
• Set up all logins and access for (PM) PI
• Enter information into Practice insights
• Assign or complete and submit enrollments when necessary
• Complete online enrollments when necessary
• Assign or register for websites to process online enrollments
• Review PI, TOPS, and websites for problems and proper set up
• Add clearinghouse and payer ID to TOPS to route claims correctly
• Troubleshoot submissions, connection problems, rejected claims, ERAs not received
• Access ERAs when escalated by the AR team
• Troubleshoot with Software Director if a transmission error occurs
• Review TOPS, PI and eBridge to see what is received in paper format, add enrollments as necessary
• Train staff on completing and submitting enrollments
• Train staff on how to troubleshoot EDI problems
• Train AR staff how to look up payments/claims and pull EOBs

InstaMed

• Set up logins and access for clients’ and PETTIGREW staff
• Complete and submit client enrollments for merchant accounts once approved update set up in TOPS
• Update call center logins so staff can accept payments for new merchant account
• Complete and submit request for statements
• Review and approve proofs for statements

Websites – Assign to team. Help when necessary.

• Register for websites
• Create logins
• Update and attest to provider information
• Review websites for EFT/ERA set up
• Assign team members to work on website tasks

TOPS – (assigned due to security level)

• Review accounts for AR when they cannot determine the reason for claim rejection.
• Update clearinghouse and payer ID as it is transferred to PI
• Load new providers
• Update addresses as needed. POS and payment address
• Run submitted claim report to check for payers going to incorrect clearinghouse
• Load contract fees

General

• Review, acceptance, and understanding of our workplace culture statement.
• The responsibilities listed in this job description are general descriptions of work assigned, duties and responsibilities may not be limited to just these responsibilities.

Work Experience Requirements:

• Experience with Excel, Microsoft Office, Internet Explorer, Gmail, Google drive and ability to learn new technology at a rapid pace
• Demonstrates effective and high level of professional communication skills (verbal and written)
• Position mandates a disposition for a high level of detail for success.
• Ability to work in a fast paced environment, demonstrate problem solving skills, demonstrate strong organizational skills and be a team player
• Must be able to prioritize efficiently and be able to switch gears at a moment’s notice.
• Experience working all aspects of the billing cycle, knowledgeable about clearinghouses and EDI processes.
• Hands on experience with credentialing government and commercial insurances.

Education Requirement(s):

• College Degree plus 5+ years of experience that is directly related to the duties and responsibilities or the equivalent in hands on experience in a working environment
• Management experience required

Manila and Iloilo, Philippines

Key Responsibilities Areas (KRA):

• Handle both inbound and outbound calls
• Handle customer requests, complaints, billing inquiries and other related concerns with the highest degree of courtesy and professionalism to resolve customer issues with one call resolution
• Prepare complete and accurate work and update customer file
• Communicate effectively with individuals / team in the program to ensure high quality and timely expedition of customer requests
• Effectively transfer misdirected customer requests to an appropriate party
• Demonstrate continued and consistent proficiency in most of the skill sets utilized within the Call Center based on WorldSource practices and operations
• Communicate with customers using web-based tools and demonstrates the associated proficiency and grammar
• May be assigned to work for another department depending on the business needs
• May be required to work in one or multiple queues or skill sets over various customer contact channels
• Contribute ideas on ways to resolve problems to better serve the customer and/or improve productivity
• Participate in activities designed to improve customer satisfaction and business performance
• Take payments and insurance information as needed and required by the client
• Ensure that good customer experience is delivered to callers and clients
• Need to meet or exceed minimum client expectations
• All other tasks and duties as assigned

Knowledge, Skills, and Abilities (KSAS):

• Good communication skills
• Professional and has good work ethics
• Must have attention to details
• Must have a good customer service skills

Qualifications:

• Must possess at least a Vocational Diploma / Short Course Certificate / Bachelor / College Degree, any field
• Must be willing to work in Iloilo City / Alabang site
• At least 1 year of working experience in the related field is an advantage
• Preferably 1 year experienced employee specializing in customer service or equivalent

Chennai, India

Job Code: WSI-AR-XXXX

Department: AR

Function Category: Medical Billing

Group/Grade: 1C

Designation: Analyst–AR

Reporting to: Team Leader -AR

Role Details :

This role is primarily working on account receivables

Area of responsibility :

• Delivering 100% production on account receivables
• Observing and learning on account specifics, knowledge's in various scopes
• Providing inputs and taking Initiatives for project improvement
• Being a team player
• Performing account manual test.
• Delivering Quality Percentage as per SLA.
• 100% Individual Attendance

Behaviour Competencies / Knowledge required and desirable :

• Analysing Skills as being an AR
• Ability to Understand and deliver as per client needs
• Internal and external Communication skills
• Maintaining Confidentiality as per HIPAA
• Basic RCM knowledge

Excellent skills in (desirable) :

• Proficient in MS office
• Typing Skills
• Communication Skills

Working Relationships/ Span of the role :

• Internal - Other AR team members, SME & Team Leader
• External - NA

Qualifications :

• Any Graduate

Experience (No. of years) :

• 0.5-2 Years of relevant experience

Location: Chennai

Other special requirement: NIL

Availability of role: High

Criticality of the role: Medium

Growth: Horizontal

Chennai, India

Job Code: WSI-Quality-1D

Department: Quality

Function Category: Medical Billing/AR

Group/Grade: 1D

Designation: QAE – Quality

Reporting to: Assistant Manager - Quality

Role Details :

This role is primarily focuses on performing on all billing and AR audits

Area of responsibility :

• Should have the end to end RCM knowledge and be capable to audit Demo, Eligibility, Charge Entry, Payments, Rejections, AR follow up and Denials
• To do Focus and Process audit
• To conduct ‘Ramp up’ meeting with new agents and provide daily feedback
• Providing advice, ideas and feedback to the team on meeting quality standards
• To take initiative in addressing the global issues
• Should provide daily feedback on the errors with corrective and preventive actions
• To be part of new projects transition for assigned project
• To learn new specialties, process/scopes
• Should perform audits for the minimum 5% or more
• Identifying inefficient or ineffective users and giving constructive feedback for their improvement
• Need to prepare daily and weekly reports
• Need to prepare the Monthly quality reports and conduct monthly meeting with the operation team
• Should identify the process gap’s and provide feedback to the operation team
• Should address focussing and improvement areas for each project
• Should address the top errors which impact the quality score and provide the quality and error trends
• Account Manual questions should be prepared
• Should monitor the agent’s calls and provide the appropriate feedback

Behaviour Competencies / Knowledge required and desirable :

• Reporting Research Results
• Analyzing & Auditing Skill
• Ability to Understand Process and deliver as per client needs
• End to End RCM Knowledge
• Internal Communication
• Attention to Detail
• Administrative Writing Skills

Excellent skills in (desirable) :

• Proficient in MS office/ Typing Skills
• Good Analytical Skill
• Good Communication Skills
• Coaching Skills

Working Relationships/ Span of the role :

• Internal - QAE’s, SQAE, Assistant Manager
• External - Clients (Specify name if any)

Qualifications :

• Graduate in any Stream or equivalent;

Experience (No. of years) :

• Minimum 4 Years of Healthcare Experience

Location: Chennai

Other special requirement: Should have the experience into Quality for the minimum of 1 year

Availability of role: High

Criticality of the role: High

Growth: Horizontal

Manila and Iloilo, Philippines

Key Responsibilities:

• Make accurate reports and effectively present them to the authorized users.
• In-charge of important documents and store them for utilization of the operations department.
• Add new material to file records and create new records as necessary.
• Responsible for the collection of data and the generation of reports to support the operation.
• Prepares report and statistical data for internal and external clients

Qualifications:

• Knowledgeable in Microsoft Excel and Google Spreadsheet.
• Excellent typing skills with a high level of accuracy at least 60-80 wpm.
• Strong written and verbal communication skills to effectively relate the data.
• Analytical skills that allow for the development of data-driven reports.
• Ability to manage time and prioritize projects to meet deadlines.
• Keen to details

Manila and Iloilo, Philippines

Key Responsibilities Areas (KRA):

• Ensure medical billing and insurance carriers pay and process claims correctly through coding the proper and appropriate medical codes (ICD-10, CPT)
• Summary, read and review patient medical records in order to summarize in alpha numerical codes the physician work performed, patient diagnosis and other information and codes required. Codes are applied in accordance with USA government industry and company procedures, laws and regulations.
• Abstract and codes diagnoses, operations, procedures, physicians and payor classes from health records by using appropriate classification systems, standards and procedures
• Compile information and data from health records, internal and CPT guidelines, as well as computer systems for use in the evaluation of quality of care and utilization review
• Confer with supervisors to assure complete, current and accurate records
• Operate computer to process, store and retrieve health information
• All other tasks and duties as assigned

Knowledge, Skills, and Abilities (KSAS):

• Knowledgeable in coding process
• Professionalism and strong work ethic
• Teamwork and collaboration
• Task management
• Ability to provide accurate information in coding
• Ability to reach and maintain required criteria

Qualifications:

• With at least 1 year experience as a Medical Coder
• Holding a CPC license is an advantage
• Must possess at least a Vocational Diploma / Short Course Certificate / Bachelor / College Degree, any field
• Must be willing to work in Iloilo City / Alabang site
• Preferably 1 year experienced employee specializing in customer service or equivalent