Job Opening - AR Caller (Hospital Billing) | 1 to 6 Years Experience

Location: Mumbai
Company: Eclat Health Solutions
HR Contact: HR Phani - (phone hidden)

Location : Office Address-

Eclat Health Solutions (I) Pvt Ltd

7TH floor of tower 1, Mindspace Juinagar, Plot no Gen 2/1/F,

TTC Industrial Area, Shiravane, Juinagar,

Navi Mumbai, Maharashtra 400705

To Apply: WhatsApp your updated CV to (phone hidden). Please avoid calling. Our HR team will contact shortlisted candidates.

Position: AR Caller - Hospital Billing (UB-04)

Experience Required:

1 - 6 Years in Hospital Billing / Accounts Receivable (AR) / Revenue Cycle Management (RCM)

Roles & Responsibilities

- Follow up on unpaid and denied hospital claims with insurance companies.
- Analyze claim denials, underpayments, and payment variances.
- Review paid claim information and identify reimbursement discrepancies.
- Work on Government and Commercial payers including Medicare, Medicaid, Managed Care, BCBS, Aetna, Cigna, UHC, Humana, etc.
- Handle claim status inquiries, appeals, reconsiderations, and escalations.
- Resolve billing-related issues to maximize collections and reduce AR days.
- Verify eligibility, benefits, coverage limitations, waiting periods, cooling periods, and authorization requirements.
- Research and resolve claim denials related to coding, billing, and payer policies.
- Document account actions accurately in billing systems.

Required Knowledge & Skills

Hospital Billing

- Strong working knowledge of UB-04 Claim Forms.




- Understanding of Type of Bill (TOB) and Revenue Codes.
- Knowledge of DRG (Diagnosis Related Group) reimbursement methodology.
- Experience handling DRG Downgrades and DRG payment disputes.
- Understanding of POA (Present on Admission) indicators.
- Knowledge of 72-Hour Rule and claim bundling regulations.
- Familiarity with Emergency Department CPT Codes.
- Understanding of Professional vs Technical Components.
- Knowledge of Radiology Billing and Coding.

Insurance Concepts

- Medicaid Spend Down knowledge.
- Coordination of Benefits (COB).
- Birthday Rule determination.
- Waiting Period and Cooling Period analysis.
- Coverage verification and benefit investigation.

Payment & Denials

- Experience identifying and resolving:
- Underpayments
- Claim denials
- Claim edits
- Authorization denials
- Medical necessity denials
- Coding denials
- Eligibility denials

Adjustment & Remark Codes

Knowledge of denial and adjustment codes including:

- CO-18 Duplicate Claim/Service
- CO-22 Coordination of Perks
- CO-50 Medical Necessity Not Met
- CO-197 Precertification/Authorization Required

Coding Knowledge

- Basic ICD-10, CPT and HCPCS understanding.
- Revenue Code validation.
- Modifier usage and reimbursement impact.

Modifier Knowledge

Experience with:

- Modifier 24 – Unrelated E&M; During Postoperative Period
- Modifier 25 – Significant Separately Identifiable E&M; Service
- Modifier 50 – Bilateral Procedure

📌 HB AR callers / Hospital Billing AR/ Mumbai/ Ub04 / HB / AR Calling
🏢 Eclat Health Solutions
📍 Mumbai