Role & responsibilities

- Perform daily AR follow-up on outstanding insurance claims to ensure timely claim resolution and reimbursement.

- Contact insurance companies through payer portals and phone calls to obtain accurate claim status.

- Follow up on denied, rejected, unpaid, underpaid, and pending claims based on account priority and aging.

- Review EOBs/ERAs to understand payment details, denial reasons, contractual adjustments, patient responsibility, and claim discrepancies.

- Analyze claim status and determine the appropriate next action, such as resubmission, corrected claim, reconsideration, appeal, or further payer follow-up.

- Work on assigned AR accounts based on 30, 60, 90, 120+ day aging and payer-specific priorities.

- Identify the root cause of claim denials and take appropriate corrective action.

- Handle payer follow-up for issues such as eligibility, authorization, medical necessity, coding, timely filing, duplicate claims, bundling, coordination of benefits, and other payer-related denials.

- Verify claim submission details, including patient information, insurance information, CPT/HCPCS codes, diagnosis codes, modifiers, and billed amounts when required.

- Review CMS-1500 and UB-04 claim information to understand claim and billing discrepancies.

- Document every payer interaction accurately in the AR/RCM system, including call reference numbers, representative details, claim status, denial reason, and next follow-up date.

- Maintain accurate and complete account notes according to company and client requirements.

- Track follow-up dates and ensure claims are worked within the required turnaround time (TAT).

- Identify underpayments and contractual discrepancies and escalate or route them for appropriate action.

- Follow up on claims requiring additional documentation or information from the provider/client.

- Submit or coordinate appropriate appeals, reconsiderations,



corrected claims, and medical record requests based on payer requirements and process guidelines.

- Monitor assigned accounts and ensure no claims are missed or unnecessarily aged.

- Prioritize high-value, high-risk, and aging accounts based on business requirements.

- Escalate complex payer issues, recurring denials, and critical/high-value accounts to the appropriate Team Lead or SME.

- Coordinate with Billing, Coding, Payment Posting, Denial Management, and other RCM teams to resolve account-level issues.

- Review payment and adjustment information to identify discrepancies that may require AR follow-up.

- Maintain productivity and quality targets as defined by the organization.

- Meet daily/weekly/monthly AR calling and follow-up targets while maintaining accuracy and quality.

- Follow payer-specific guidelines, client processes, and internal SOPs during claim follow-up.

- Ensure compliance with HIPAA requirements, company policies, and applicable US healthcare billing regulations.

- Maintain qualified communication with insurance representatives and internal stakeholders.

- Provide timely updates to the Team Lead regarding difficult accounts, payer issues, and recurring process problems.

- Identify recurring denial trends and communicate them to the Team Lead for further analysis and corrective action.

- Participate in process training, refresher sessions, quality feedback, and team meetings.

- Support continuous improvement initiatives aimed at reducing AR aging, denials, rework, and outstanding balances.

- Take ownership of assigned accounts and ensure appropriate follow-up until resolution or escalation.

Preferred candidate profile

- Minimum 1 + Year into AR Calling(Physician Billing)-Voice Process, Denial Management

- Excellent communication skills

Perks and Benefits

- US-Shifts(6.00 PM - 3:00 AM)

- 5 days working

- 2 days fixed week off

- 1 way cab facility(Drop)

📌 AR Caller - Physician Billing (Hyderabad)
🏢 Talentboon Consulting
📍 Hyderabad