N
- Key Responsibilities for AR:
N
- Review account thoroughly, including any prior comments on the account, EOBs / ERAs / Correspondence, and perform pre-resolution analysis.
N
- Understand the reason for rejection, denials, or no status from the payer.
N
- 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.
N
- Take appropriate actionto 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.
N
- Documentation of all the actions on the practice management system and workflow management system, and maintain an audit trail.
N
- Ensure adherence to Standard Operating Procedures and compliance.
N
- Highlight any global trend/pattern and issue escalation with the leadership team.
N
- Meet the productivity and quality target on a daily/monthly basis.
N
- Upskill by learning new/additional skills and enhancing competencies. Active participation in all process/client-specific training and refresher training.
N
- Requirements:
N
- Undergraduate / Graduate in any stream with 2 to 4 years of experience in US Healthcare RCM for Account Receivable / Denial Management Resolution.
N
- Fluent communication, both verbal and written.
N
- Good analytical skills,attention to detail, and resolution-oriented.
N
- Should have knowledge about the RCM end-to-end cycle and proficiency in AR fundamentals and denial management.
N
- Basic knowledge of computers and MS Office.
N
- Key Responsibilities for EVBV:
N
- Review and verify patient insurance coverage, eligibility, and benefits prior to appointments or claim submission.
N




- Conduct insurance verification through payer websites, IVR systems, or direct calls to insurance companies.
N
- Accurately document insurance advantages, co-pays, deductibles, co-insurance, and coverage limitations in the practice management system.
N
- Identify discrepancies or inactive policies and escalate or resolve them as appropriate.
N
- Maintain up-to-date knowledge of insurance plans, benefit structures, and payer guidelines.
N
- Ensure timely and accurate completion of verifications as per client SLA or daily targets.
N
- Adhere to Standard Operating Procedures (SOPs) and compliance guidelines.
N
- Escalate payer-related issues, trends, or delays to team leads or management.
N
- Participate in client-specific training and continuous upskilling programs.
N
- Requirements:
N
- Undergraduate / Graduate in any stream with 1 to 3 years of experience in US Healthcare RCM, specifically in Eligibility &

Benefits Verification.

N
- Strong communication skills (verbal and written) with clarity and professionalism during payer calls.
N
- Proficient in working with payer portals, IVR systems, and MS Office tools.
N
- Basic understanding of insurance terminology (e.G., HMO, PPO, deductible, co-pay, out-of-network).
N
- Ability to work under deadlines with strong attention to detail and accuracy.
N
- Knowledge of the end-to-end RCM process and patient access cycle is preferred.
N

nKey Responsibilities for Authorization:

N





n
- Review patient and procedure details to determine if prior authorization is required based on payer policies.
N
- Obtain authorizations by submitting complete and accurate information through payer portals, fax, or direct calls.
N
- Understand and follow payer-specific authorization guidelines and timelines.
N
- Track and follow up on pending authorization requests and escalate issues if needed.
N
- Ensure timely documentation of authorization numbers, approval dates, and denial reasons in the practice management system.
N
- Communicate with providers, patients, and internal teams regarding authorization status and requirements.
N
- Respond to reauthorization requests or additional information required by payers.
N
- Maintain compliance with HIPAA and payer-specific regulations.
N
- Stay updated with changes in authorization requirements and payer-specific guidelines.
N
- Meet daily/weekly targets for authorization submissions and follow-ups.
N
- Participate actively inteam meetings, training sessions, and process improvements.
N
- Requirements:
N
- Undergraduate / Graduate in any stream with 1 to 3 years of experience in US Healthcare RCM, specifically in Authorization Management.
N
- Experience in submitting and managing authorization requests via insurance portals, fax, or telephonic communication.
N
- Sound knowledge of payer-specific requirements for different specialties (e.G., radiology, DME, sleep studies, surgeries, etc.).
N
- Excellent communicationskills (both verbal and written), especially for handling payer calls.
N
- Familiarity with documentation and record-keeping in EHR/EMR or RCM systems.
N
- Basic proficiency in MSOffice and navigating web-based payer platforms.
N

📌 Hiring: Ar Callers & Denial Management, Evbv, Authorization Specialists - (Medical Billing) (India)
🏢 RevUpside Business Solutions Private
📍 India