AR Caller cum Analyst

Responsibilities:

• Make outbound calls to insurance companies to inquire about the status of claims.
• Identify and resolve claim denials, exceptions, or exclusions.
• Read and interpret insurance Explanation of Benefits (EOBs).
• Maintain accurate and detailed notes regarding collection efforts.
• Follow up on unpaid claims within standard billing cycle timeframes.
• Investigate and appeal denied claims.
• Handle patient inquiries on account status and charges.
• Maintain strict confidentiality in accordance with HIPAA regulations and company policy.
• Work with the billing team to ensure all bills have been dispatched to the relevant parties.
• Stay informed about changes in insurance policies, procedures, and regulations.

Qualifications:

• High School Diploma or equivalent; further education in a related field will be a plus.
• Previous experience in AR calling is preferred, but not mandatory.
• Strong knowledge of medical insurance (HMO, PPO, Medicare, Medicaid, etc.).
• Understanding of medical terminology, ICD-10, CPT, and HCPCS coding.
• Proficient in MS Office and data entry, experience with medical software preferred.
• Excellent communication, negotiation, and problem-solving skills.
• Attention to detail and ability to analyze insurance EOBs.
• Ability to maintain professionalism and a positive service attitude at all times.
• Willingness to stay up-to-date with healthcare laws and regulations.
• Respect for patient confidentiality and adherence to HIPAA guidelines.
• Ability to work independently and manage time efficiently.

Responsibilities:

• Analyze and resolve issues related to unpaid medical claims and denied claims.
• Follow up with insurance companies to inquire about claim status and resolve issues.
• Interpret Explanation of Benefits (EOBs) to ensure correct payment, adjustments, and patient responsibility.
• Communicate with providers and patients regarding billing issues, as needed.
• Document all activities related to accounts receivable follow-up in a consistent and comprehensive manner.
• Meet key performance indicators as established by management, such as reducing the number of denied and rejected claims.
• Review and appeal unpaid and denied claims.
• Maintain patient confidentiality and adhere to HIPAA regulations.
• Stay up-to-date with changes in medical coding and billing practices, insurance policies, and healthcare regulations.

Qualifications:

• Bachelor's degree in Finance, Business, Healthcare Management, or a related field.
• 1-2 years of experience in medical billing or healthcare, preferred but not necessary.
• Understanding of medical terminology, CPT, ICD-10, and HCPCS coding.
• Proficiency in using medical software systems and Microsoft Office Suite.
• Excellent written and verbal communication skills.
• Detail-oriented with strong analytical and problem-solving abilities.
• Understanding of insurance guidelines, including Medicare and state Medicaid.
• Ability to maintain patient confidentiality and adhere to HIPAA guidelines.
• Ability to work independently and collaboratively within a team environment.
• Able to prioritize and manage multiple tasks simultaneously.
• Strong customer service skills for interacting with patients regarding medical claims and payments.
• Willingness to stay up-to-date with changes in healthcare laws and regulations.