AR Callers

Key Responsibilities for AR:- Review account thoroughly, including any prior comments on the account, EOBs / ERAs / Correspondence, and perform pre-resolution analysis.- Understand the reason for rejection, denials, or no status from the payer.- Work on the resolution of the claim by performing follow-up with the payer using the most optimal method, i.e., calling, IVR, web, or email.- Take appropriate action to move the account towards resolution, including rebilling the claim, sending claims for reprocessing, reconsideration, redetermination, appeal (portal/web, fax, mail), verifying eligibility and benefits, and managing management hand-off with the client and internal teams.- Documentation of all the actions on the practice management system and workflow management system, and maintain an audit trail.- Ensure adherence to Standard Operating Procedures and compliance.- Highlight any global trend/pattern and issue escalation with the leadership team.- Meet the productivity and quality target on a daily/monthly basis.- Upskill by learning new/additional skills and enhancing competencies. Active participation in all process/client-specific training and refresher training.Requirements:- Undergraduate / Graduate in any stream with 2 to 4 years of experience in US Healthcare RCM for Account Receivable / Denial Management Resolution.- Fluent communication, both verbal and written.- Good analytical skills, attention to detail, and resolution-oriented.- Should have knowledge about the RCM end-to-end cycle and proficiency in AR fundamentals and denial management.- Basic knowledge of computers and MS Office.Key Responsibilities for EVBV:- Review and verify patient insurance coverage, eligibility, and benefits prior to appointments or claim submission.- Conduct insurance verification through payer websites, IVR systems, or direct calls to insurance companies.- Accurately document insurance benefits, co-pays, deductibles, co-insurance, and coverage limitations in the practice management system.- Identify discrepancies or inactive policies and escalate or resolve them as appropriate.- Maintain up-to-date knowledge of insurance plans, benefit structures, and payer guidelines.- Ensure timely and accurate completion of verifications as per client SLA or daily targets.- Adhere to Standard Operating Procedures (SOPs) and compliance guidelines.- Escalate payer-related issues, trends, or delays to team leads or management.- Participate in client-specific training and continuous upskilling programs.Requirements:- Undergraduate / Graduate in any stream with 1 to 3 years of experience in US Healthcare RCM, specifically in Eligibility & Benefits Verification.- Strong communication skills (verbal and written) with clarity and professionalism during payer calls.- Proficient in working with payer portals, IVR systems, and MS Office tools.- Basic understanding of insurance terminology (e.g., HMO, PPO, deductible, co-pay, out-of-network).- Ability to work under deadlines with strong attention to detail and accuracy.- Knowledge of the end-to-end RCM process and patient access cycle is preferred.Key Responsibilities for Authorization:- Review patient and procedure details to determine if prior authorization is required based on payer policies.- Obtain authorizations by submitting complete and accurate information through payer portals, fax, or direct calls.- Understand and follow payer-specific authorization guidelines and timelines.- Track and follow up on pending authorization requests and escalate issues if needed.- Ensure timely documentation of authorization numbers, approval dates, and denial reasons in the practice management system.- Communicate with providers, patients, and internal teams regarding authorization status and requirements.- Respond to reauthorization requests or additional information required by payers.- Maintain compliance with HIPAA and payer-specific regulations.- Stay updated with changes in authorization requirements and payer-specific guidelines.- Meet daily/weekly targets for authorization submissions and follow-ups.- Participate actively in team meetings, training sessions, and process improvements.Requirements:- Undergraduate / Graduate in any stream with 1 to 3 years of experience in US Healthcare RCM, specifically in Authorization Management.- Experience in submitting and managing authorization requests via insurance portals, fax, or telephonic communication.- Sound knowledge of payer-specific requirements for different specialties (e.g., radiology, DME, sleep studies, surgeries, etc.).- Excellent communication skills (both verbal and written), especially for handling payer calls.- Familiarity with documentation and record-keeping in EHR/EMR or RCM systems.- Basic proficiency in MS Office and navigating web-based payer platforms.