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Key Responsibilities:
- Review and analyze unpaid/denied claims and initiate appropriate follow-up.
- Make outbound calls to US insurance companies (payers) to resolve claims.
- Understand and interpret Explanation of Benefits (EOBs) and Claim Adjustment Reason Codes (CARCs).
- Work on claim re-submissions, appeals, and denial resolutions.
- Update the billing system with clear and accurate documentation of actions taken.
- Meet daily, weekly, and monthly productivity targets (e.g., call volume, aging resolution).
- Ensure compliance with HIPAA and company policies.
Required Qualifications:
Education: Any graduate (Life Science or Healthcare background preferred).
Experience:
- Freshers: With excellent communication skills and interest in US healthcare.
- Experienced: 13 years in AR Calling / Medical Billing / Denial Management.
Skills:
- Excellent verbal communication in English.
- Basic understanding of the US healthcare RCM process.
- Knowledge of insurance types (Medicare, Medicaid, Commercial).
- Familiarity with denial codes and resolution techniques.
- Proficient in MS Excel and billing software (e.g., NextGen, Kareo, Athena, eClinicalWorks).
