AR caller - Denial Management

1 - 5 years

2 - 4 Lacs

Posted:12 hours ago| Platform: Foundit logo

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On-site

Job Type

Full Time

Job Description

AR Caller - Denial Management

Must Have Skills

  • Experience as an AR Caller in Denial Management

    : Proven background in Accounts Receivable (AR) calling, specifically focused on the resolution of denied claims.
  • Good understanding of denial reasons (CO, OA, PR codes) and appeal processes

    : In-depth knowledge of common denial codes (Contractual Obligation, Other Adjustments, Patient Responsibility) and the ability to navigate complex appeal procedures.
  • Familiarity with healthcare insurance terminology, CPT/ICD coding basics

    : Basic understanding of terms used in healthcare insurance and foundational knowledge of CPT (Current Procedural Terminology) and ICD (International Classification of Diseases) coding.
  • Strong analytical and problem-solving skills

    : Ability to thoroughly analyze denied claims, identify root causes, and develop effective strategies for resolution.
  • Excellent communication skills (both verbal and written)

    : Clear and professional communication to interact effectively with insurance companies and document interactions.
  • Proficiency in working with RCM software/tools like EPIC, Athena, eClinicalWorks, etc.

    : Hands-on experience with popular Revenue Cycle Management (RCM) software and tools to manage claims and denials.
  • Typing speed of at least 30 WPM with accuracy

    : Efficient typing skills to ensure quick and accurate data entry and documentation.
  • Ability to multitask and meet deadlines under pressure

    : Capability to handle multiple denied claims simultaneously and ensure timely resolution within set targets.

Good to Have Skills

  • Knowledge and expertise in AR Caller in Denial Management

    : Comprehensive understanding and advanced proficiency in the processes and best practices related to AR calling for denial management.

Roles and Responsibilities

  • Review and analyze insurance claim denials

    from various payers, understanding the specific reasons for denial.
  • Make outbound calls to insurance companies

    to proactively resolve denied or unpaid claims, advocating for appropriate reimbursement.
  • Identify the root cause of denials

    (e.g., coding errors, eligibility issues, authorization lapses, medical necessity), performing detailed investigations.
  • Take appropriate actions

    such as preparing and filing appeals, making necessary claim corrections, or rebilling claims to ensure proper processing.
  • Document all activities accurately

    in the client system or internal tools, maintaining clear and concise records of interactions and resolutions.
  • Follow-up on pending claims

    within the specified Turnaround Time (TAT), ensuring consistent progress towards claim resolution.
  • Communicate effectively with insurance representatives

    and

    escalate complex issues

    to supervisors or other departments when needed, ensuring timely attention to challenging cases.
  • Work collaboratively with internal teams

    (such as coding and billing) to identify and resolve recurring denial trends, contributing to process improvements.
  • Stay updated with payer-specific guidelines and industry regulations

    (e.g., HIPAA compliance) to ensure all denial management activities adhere to current standards.

Qualification

  • Any Graduate and Undergraduate

CTC Range

  • 3 to 4.8 LPA (Lakhs Per Annum)

Notice Period

  • Immediate

Interview Mode

  • Virtual

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