Job Description

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- Key Responsibilities for AR:

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- Review account thoroughly, including any prior comments on the account, EOBs / ERAs / Correspondence, and perform pre-resolution analysis.

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- Understand the reason for rejection, denials, or no status from the payer.

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- 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.

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- Take appropriate action to 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.

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- Documentation of all the actions on the practice management system and workflow management system, and maintain an audit trail.

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- Ensure adherence to Standard Operating Procedures and compliance.

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- Highlight any global trend/pattern and issue escalation with the leadership team.

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- Meet the productivity and quality target on a daily/monthly basis.

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- Upskill by learning new/additional skills and enhancing competencies. Active participation in all process/client-specific training and refresher training.

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- Requirements:

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- Undergraduate / Graduate in any stream with 2 to 4 years of experience in US Healthcare RCM for Account Receivable / Denial Management Resolution.

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- Fluent communication, both verbal and written.

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- Good analytical skills, attention to detail, and resolution-oriented.

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- Should have knowledge about the RCM end-to-end cycle and proficiency in AR fundamentals and denial management.

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- Basic knowledge of computers and MS Office.

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- Key Responsibilities for EVBV:

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- Review and verify patient insurance coverage, eligibility, and perks prior to appointments or claim submission.





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- Conduct insurance verification through payer websites, IVR systems, or direct calls to insurance companies.

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- Accurately document insurance benefits, co-pays, deductibles, co-insurance, and coverage limitations in the practice management system.

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- Identify discrepancies or inactive policies and escalate or resolve them as appropriate.

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- Maintain up-to-date knowledge of insurance plans, benefit structures, and payer guidelines.

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- Ensure timely and accurate completion of verifications as per client SLA or daily targets.

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- Adhere to Standard Operating Procedures (SOPs) and compliance guidelines.

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- Escalate payer-related issues, trends, or delays to team leads or management.

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- Participate in client-specific training and continuous upskilling programs.

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- Requirements:

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- Undergraduate / Graduate in any stream with 1 to 3 years of experience in US Healthcare RCM, specifically in Eligibility & Benefits Verification.

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- Strong communication skills (verbal and written) with clarity and professionalism during payer calls.

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- Proficient in working with payer portals, IVR systems, and MS Office tools.

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- Basic understanding of insurance terminology (e.g., HMO, PPO, deductible, co-pay, out-of-network).

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- Ability to work under deadlines with strong attention to detail and accuracy.

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- Knowledge of the end-to-end RCM process and patient access cycle is preferred.

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Key Responsibilities for Authorization:

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- Review patient and procedure details to determine if prior authorization is required based on payer policies.

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- Obtain authorizations by submitting complete and accurate information through payer portals, fax, or direct calls.

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- Understand and follow payer-specific authorization guidelines and timelines.

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- Track and follow up on pending authorization requests and escalate issues if needed.

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- Ensure timely documentation of authorization numbers, approval dates, and denial reasons in the practice management system.

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- Communicate with providers, patients, and internal teams regarding authorization status and requirements.

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- Respond to reauthorization requests or additional information required by payers.

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- Maintain compliance with HIPAA and payer-specific regulations.

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- Stay updated with changes in authorization requirements and payer-specific guidelines.

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- Meet daily/weekly targets for authorization submissions and follow-ups.

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- Participate actively in team meetings, training sessions, and process improvements.

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- Requirements:

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- Undergraduate / Graduate in any stream with 1 to 3 years of experience in US Healthcare RCM, specifically in Authorization Management.

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- Experience in submitting and managing authorization requests via insurance portals, fax, or telephonic communication.

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- Sound knowledge of payer-specific requirements for different specialties (e.g., radiology, DME, sleep studies, surgeries, etc.).

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- Excellent communication skills (both verbal and written), especially for handling payer calls.

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- Familiarity with documentation and record-keeping in EHR/EMR or RCM systems.

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- Basic proficiency in MS Office and navigating web-based payer platforms.

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📌 AR Callers & Denial Management, EVBV, Authorization Specialists - (Medical Billing) (Mumbai)
🏢 RevUpside Business Solutions Private
📍 Mumbai