INFOPARK

Virtual Receptionist (US Voice Process)

Please find below.

Duties and Responsibilities - Virtual Receptionist

● Serves patients by greeting and helping them, scheduling appointments, and maintaining records and accounts.
● Welcomes patients and visitors in person or on the telephone, and answers or refers inquiries.
● Comforts patients by anticipating patients’ anxieties, answering patients’ questions, and maintaining the reception area.
● Helps patients in distress by responding to emergencies.
● Protects patients’ rights by maintaining confidentiality of medical, personal, and financial information.
● Maintains operations by following policies and procedures, reporting needed
changes.
● Keeps patient appointments on schedule by notifying providers of patient’s arrival.

Requirements:
Must have excellent communication skills
Experience in the US voice process is desirable.
Should be willing to work in night shift.
Freshers are welcome.

Certified Professional Medical Auditor (CPMA)

Job Summary
We are seeking a highly detailed and analytical Certified Professional Medical Auditor
(CPMA) to join our team. This role is responsible for conducting comprehensive, end-to-end
audits of the entire claim lifecycle, from initial patient encounter to final account resolution.
The ideal candidate will leverage their expertise in coding, billing, and compliance to identify
inaccuracies, revenue leakage, and non-compliance with payer guidelines and standard
practices. This position will be instrumental in improving the accuracy, efficiency, and timeliness
of our revenue cycle operations.

Roles and Responsibilities
Your primary responsibility will be to perform detailed audits across all stages of the revenue
cycle.
Core Audit Functions
● Clinical Documentation & Encounter Audit:
○ Review clinical documentation to ensure the services billed are fully supported,
medically necessary, and accurately reflect the care provided.
○ Verify that a billable encounter is properly established and documented for each
claim created.
○ Audit for specificity in documentation to support correct ICD-10, CPT, and
HCPCS code selection.
● Front-End & Charge Capture Audit:
○ Audit patient demographic (demo) entry and insurance verification records for
completeness and accuracy (e.g., correct spelling of names, DOB, policy
numbers).
○ Review the charge entry (charge capture) process to ensure all services
documented were correctly charged and that no unbundling or upcoding
occurred.
○ Validate that CPT/HCPCS codes and modifiers are used correctly according to
NCCI (National Correct Coding Initiative) edits and payer-specific policies.

● Claims & Billing Audit:
○ Analyze submitted claims (CMS-1500 or UB-04) to confirm they are "clean" and
adhere to all payer guidelines and standard billing practices.
○ Verify that claims are submitted within the payers' timely filing limits.
○ Identify trends in claim rejections and denials originating from submission errors.
● Back-End & Follow-up Audit:
○ Audit payment posting to ensure payments, adjustments, and patient
responsibilities are posted accurately against the correct charges.
○ Verify that contractual adjustments are applied correctly based on payer fee
schedules and contracts.
○ Evaluate the quality and effectiveness of Accounts Receivable (AR) follow-up
actions, including the rework of denied claims and the substance of appeals.

Process & Timeliness Audits
● Timeliness & Efficiency:
○ Audit the turnaround time (TAT) at each stage of the claim lifecycle (e.g., charge
lag, claim submission lag, payment posting lag, denial rework time).
○ Monitor key performance indicators (KPIs) such as Days in AR, Clean Claim
Rate, and Denial Rate to identify bottlenecks and delays.

● Reporting & Education:
○ Prepare detailed audit reports with findings, root cause analysis, and quantifiable
financial impact.
○ Present findings and corrective action recommendations to department
managers and staff.
○ Serve as a subject matter expert, providing education and feedback to coders,
billers, front-desk staff, and AR teams to prevent future errors.

● Compliance:
○ Ensure all audited processes remain in strict compliance with federal and state
regulations, including HIPAA and OIG guidelines.
○ Assist in external audits (e.g., RAC, payer) as needed.

Qualifications and Skills
Required:
● CPMA (Certified Professional Medical Auditor) certification from the AAPC.
● Additional Certification: Must also hold at least one of the following: CPC (Certified
Professional Coder), COC (Certified Outpatient Coder), or CPB (Certified Professional
Biller).

● Experience: Minimum of 3-5 years of hands-on experience in medical auditing, coding,
or full-cycle revenue cycle management.

● Expert Knowledge: Deep understanding of medical terminology, anatomy, CPT, ICD-
10-CM, and HCPCS Level II coding systems.

● Payer Expertise: Proficient in interpreting commercial, Medicare, and Medicaid payer
policies and reimbursement guidelines.
● Analytical Skills: Strong analytical and problem-solving skills with an ability to identify
trends and patterns in complex data.
● Communication: Excellent written and verbal communication skills, with the ability to
present complex audit findings clearly and professionally.
● Software: Proficiency in using EMR/EHR systems and Practice Management (PM)
software. Strong skills in Microsoft Excel for data analysis and reporting.
Preferred:
● Experience auditing both physician (pro-fee) and facility (outpatient) claims.
● Associate's or Bachelor's degree in Healthcare Administration, Business, or a related
field.
● Experience with data analytics tools or advanced Excel functions (e.g., pivot tables, VLOOKUP).