Medical Billing - AR Caller

Job Summary:

We are looking for an experienced AR Caller with a strong background in managing and resolving denials within the medical billing industry. The ideal candidate will have 3 to 5 years of experience specifically in handling denials, appeals, and managing the accounts receivable process for medical claims. This role requires a keen understanding of insurance processes, payer guidelines, and the ability to resolve billing issues efficiently.

Key Responsibilities:

• Denial Management:
• Review and analyze denied claims to determine the root cause of the denial.
• Perform detailed research on denials, including reviewing payer policies and patient information.
• Work closely with insurance providers to resolve denials, either through resubmission, appeals, or follow-up communications.
• Maintain accurate documentation of denial resolution activities and track the status of each claim.

• Accounts Receivable Follow-Up:
• Follow up with insurance companies, patients, and healthcare providers on outstanding claims to ensure timely payment.
• Address any coding issues, claim discrepancies, or missing information that may have resulted in denials or delays.
• Effectively communicate with insurance companies and patients to resolve issues and ensure prompt payment.

• Appeals Process:
• Prepare and submit appeals for denied claims, including providing necessary documentation, supporting evidence, and corrective actions.
• Work with the billing and coding teams to ensure accurate and compliant claim submissions.
• Stay updated on payer policies and guidelines to prevent future denials and improve the success rate of appeals.

• Reporting and Analysis:
• Generate reports on denied claims, payment trends, and outstanding balances for internal review and management reporting.
• Analyze denial trends and collaborate with the team to improve the overall claim resolution process.
• Provide feedback to the billing team on recurring denial issues and suggest improvements to billing practices.

• Collaboration and Communication:
• Work closely with the coding, billing, and management teams to resolve complex issues related to claims denials and unpaid balances.
• Provide clear communication to patients regarding their insurance claims, balances, and payment options when necessary.

• Compliance and Documentation:
• Ensure compliance with industry regulations and payer guidelines when working with denied claims and payments.
• Maintain complete and accurate records of all communications, actions taken, and resolutions for each claim.

Skills and Qualifications:

• Experience: 3 to 5 years of experience in Accounts Receivable within the healthcare industry, specifically in handling denials and appeals in medical billing.
• Denial Management Expertise: In-depth knowledge of payer denial reasons, healthcare insurance guidelines, and the appeals process.
• Communication Skills: Strong verbal and written communication skills to effectively handle payer follow-ups, denial appeals, and patient interactions.
• Analytical Skills: Ability to analyze denials and identify root causes, with a focus on improving collection rates.
• Medical Billing Knowledge: Understanding of medical billing codes (CPT, ICD-10, HCPCS), insurance verification, and claim submission processes.
• Software Proficiency: Familiarity with RCM software, practice management systems (e.g., Epic, Cerner, NextGen), and Microsoft Office Suite (Excel, Word).
• Attention to Detail: Strong attention to detail in reviewing claims, denials, and documentation.
• Problem-Solving: Proven ability to resolve complex billing issues and denials with minimal oversight.

Education:

• Preferred: Associate's or Bachelor's degree in Health Information Management, Healthcare Administration, Finance, or a related field.
• Certifications (Preferred but not required): Certified Professional Coder (CPC), Certified Healthcare Billing and Coding Specialist (CHBMS), or similar.

NOTE :

Looking for Immediate Joiners

Work from Office

Office Location - JP Nagar 2nd Phase

Contact :

9606018324 ( Rakesh M V )