Healthcare Back Office Executive

ABOUT THE ROLE 

Project Tree is starting a back-office service for clinics and doctors in the USA. Working from the Ahmedabad office, this role combines patient support over the phone with end-to-end medical billing for US clinics. The key mission is to code and submit claims correctly so that the clinic receives its insurance payment. 

KEY RESPONSIBILITIES 

1. Call Handling & Patient Service 

• Answer inbound calls from US patients, clinics and doctors professionally and resolve their queries on billing, claims and insurance. 

• Record every call and its outcome in Dr Pro. 

• Book patient appointments with doctors and specialists. 

• Follow up with patients, clinics and insurance companies on pending matters.

2. Insurance Verification & Authorization 

• Verify patient insurance eligibility and coverage over the phone. 

• Obtain prior authorization from insurance companies before treatment, where required. 

3. Medical Billing & Coding 

• Pre-claim: review the doctor’s documentation and assign the correct billing codes. 

• Generate the bill and submit the claim with billing codes to the insurance company. 

• Ensure claims are clean and error-free to avoid denials and delays. 

• Post-claim: track claim status, handle denials or rejections, correct and resubmit, and ensure the insurance payment is received. 

• Post received payments and reconcile them against claims. 

• Escalate unresolved cases to the reporting manager on time. 

4. Documentation & Compliance 

• Maintain complete and accurate records of calls, claims and payments in Dr Pro. 

• Keep all patient information strictly confidential as per US HIPAA rules and company policy. 

• Meet daily targets for calls, claims and accuracy; share daily work reports. 

REQUIREMENTS 

• Experience: Minimum 5 years in US medical billing / US healthcare back office (RCM). 

• English: Good spoken and written English is mandatory, with clear telephone communication. 

• Medical Knowledge: Sound knowledge of medical terminology, CPT/ICD-10 coding and US insurance (Medicare, Medicaid, commercial payers). 

• Shift: Must be willing to work a fixed night shift (mandatory). 

• Computer: Good typing speed; comfortable with software applications, MS Excel and email. 

• Education: Graduate in any stream (Life Sciences, Pharmacy, Nursing or B.Com preferred). 

• Advantage: Medical coding certification (CPC / CCS) or experience on medical billing software.

KEY SKILLS 

• Customer service and active listening 

• Attention to detail and accuracy in coding 

• Strong follow-up and problem-solving 

• Ability to learn new software quickly 

WHAT WE OFFER 

• Salary: No bar for the right candidate. 

• Training on Dr Pro application and processes. 

• Opportunity to grow with a new service line from the start.