Summary

As an AR Appeals & Credentialing Specialist, you will be responsible for managing denied, underpaid, and outstanding insurance claims, preparing and following up on appeals and reconsiderations, and supporting provider credentialing and payer enrollment activities. The role requires close coordination with insurance payers, billing, credentialing, and internal teams to resolve claim issues, maintain accurate provider information, and support timely reimbursement.

Location: Sakinaka (Andheri East), Mumbai

Working Days: Monday to Friday (Saturday & Sunday Off)

Shift: US Shift (Night Shift)

Key Responsibilities:

AR Appeals & Denial Management

- Review and analyze outstanding AR, aging reports, denial reports, and payer-specific work queues.
- Investigate denied, rejected, and underpaid claims to identify the root cause of non-payment.
- Review EOBs, ERAs, denial codes, payer correspondence, and claim history.
- Determine appropriate resolution, including claim correction, reprocessing, reconsideration, or appeal.
- Prepare and submit appeals and reconsiderations with required supporting documentation within payer filing deadlines.
- Research payer-specific appeal guidelines, requirements, and timely filing limits.
- Follow up with insurance payers through phone, portals, email, and written correspondence.
- Obtain and accurately document claim status, denial reasons, appeal requirements, reference numbers, filing deadlines, and payer representative details.
- Identify and investigate potential underpayments by comparing payer reimbursement against expected or contracted reimbursement, where applicable.
- Escalate complex or recurring payer issues to management and coordinate with billing and other operational teams for resolution.
- Maintain accurate and timely documentation of all AR and appeal activities in the relevant RCM/billing systems.

Credentialing & Payer Enrollment





- Support provider credentialing and enrollment with commercial and government insurance payers.
- Complete and submit provider enrollment and credentialing applications accurately and within required timelines.
- Work with payer portals and enrollment systems to monitor application status and follow up on pending applications.
- Coordinate collection, verification, and maintenance of provider credentialing documents, including CAQH information, NPI, state licenses, DEA certificates, and board certifications, where applicable.
- Process new provider enrollments, provider additions to existing group contracts, and demographic or practice-location updates.
- Support payer revalidation and recredentialing activities.
- Maintain accurate records of provider enrollment status, effective dates, payer participation, and credentialing documentation.

Credentialing-Related AR Resolution

- Investigate claims denied due to provider enrollment, credentialing, participation, or network status issues.
- Determine whether the issue requires a corrected claim, reconsideration, appeal, enrollment correction, or payer escalation.
- Coordinate with billing and credentialing teams to resolve credentialing-related denials and prevent further claim impact.
- Track recurring credentialing-related denial trends and communicate issues to management.

Reporting & Documentation

- Maintain complete and accurate notes for AR, appeals, credentialing, and payer follow-up activities.
- Update RCM, billing, credentialing, and payer systems on a timely basis.
- Meet assigned productivity, quality,



turnaround-time, and resolution targets.
- Ensure compliance with payer requirements and internal processes.

Required Skills:

- Good spoken English and professional communication skills with a neutral accent.
- 13+ years of experience in US Healthcare RCM, preferably in AR Appeals, Denial Management, or Credentialing.
- Strong understanding of the US healthcare insurance and medical billing process.
- Knowledge of CPT, HCPCS, ICD codes, EOBs, ERAs, denial codes, and claim lifecycle.
- Familiarity with Medicare, Medicaid, and commercial insurance payers.
- Working knowledge of AR follow-up, appeals, reconsiderations, underpayments, and denial resolution.
- Understanding of provider credentialing, payer enrollment, CAQH, NPI, and provider participation.
- Experience using payer portals such as Availity, NaviNet, and other payer-specific portals.
- Familiarity with EHR/RCM systems such as Tebra/Kareo, Wellfuse, Athena, eClinicalWorks, EPIC, or similar platforms.
- Good working knowledge of Microsoft Outlook, Teams, Excel, Word, and PowerPoint.
- Ability to research payer guidelines and work within strict filing and follow-up deadlines.

Desired Attributes:

- Strong analytical and problem-solving skills.
- Excellent attention to detail and accuracy.
- Ability to manage multiple claims, appeals, and credentialing activities simultaneously.
- Strong follow-up and organizational skills.
- Ability to work independently and meet strict productivity and quality targets.
- Professional approach when communicating with insurance payers and internal stakeholders.
- Ability to work effectively in a high-volume, deadline-driven environment.
- A collaborative team player with a robust focus on resolution, compliance, and revenue cycle performance.

Interested Candidates who are comfortable working Night Shifts can share their resumes.

📌 AR Appeals & Credentialing Specialist (Mumbai Suburban)
🏢 Hanr Support Services
📍 Mumbai Suburban