Roles and Responsibilities:

1.AR Follow-up & Physician Billing

• Manage day-to-day AR follow-up activities for physician billing accounts.

• Ensure timely and effective follow-up on outstanding insurance claims.

• Review and monitor AR across 30/60/90/120+ aging buckets.

• Ensure appropriate prioritization of high-value, high-aging, and critical accounts.

• Guide team members in analyzing claim status and determining appropriate next actions.

• Ensure accurate account documentation and follow-up notes in billing systems.

• Monitor pending, denied, underpaid, and unpaid claims through resolution.

• Ensure adherence to payer-specific requirements and client-defined processes.

2. Denial Management

• Oversee end-to-end denial management activities.

• Monitor denial trends and identify recurring denial reasons.

• Guide the team in performing denial root-cause analysis.

• Ensure appropriate corrective actions, rebilling, appeals, and payer follow-up.

• Monitor denial recovery and identify opportunities for revenue improvement.

• Work closely with coding, billing, payment posting, and other RCM teams to resolve

upstream issues.

• Track and reduce avoidable denials through process improvement initiatives.

3. Payer Calling & Voice Process Management

• Ensure AR callers conduct professional and effective payer calls.

• Monitor the team's ability to communicate with insurance representatives and obtain

accurate claim information.

• Coach team members on probing, negotiation, call control, questioning, and effective

communication.

• Ensure accurate capture of payer representative information, claim status, reference

numbers, payment details, and next actions.

• Handle complex payer escalations and support team members on difficult calls.

• Ensure compliance with client communication standards and voice-process requirements.

4. EOB/ERA & Claim Analysis

• Ensure the team can effectively interpret EOBs and ERAs.

• Guide team members in identifying:

- Denials
- Underpayments
- Contractual adjustments
- Patient responsibility
- Payment discrepancies
- Non-covered services
- Authorization issues
- Eligibility-related issues
- Timely filing issues

• Ensure appropriate action is taken based on payer response and claim status.

• Monitor accuracy of account updates and resolution codes.

5. Physician Billing & Claims Knowledge

• Maintain strong knowledge of physician billing and professional claims.





• Ensure team understanding of CMS-1500 claim requirements.

• Provide guidance on CPT, HCPCS, ICD-10-CM, and modifier-related billing issues.

• Understand payer reimbursement policies and contractual requirements.

• Guide the team in identifying billing, coding, eligibility, authorization, and

documentation-related issues affecting reimbursement.

6. Team Leadership & People Management

• Lead, mentor, and manage a team of AR callers.

• Allocate accounts and workloads based on team capacity, priorities, aging, and business

requirements.

• Conduct daily huddles and communicate operational priorities.

• Monitor individual and team performance against defined KPIs.

• Provide regular coaching, feedback, and performance guidance.

• Identify training needs and coordinate with the Training/QA teams.

• Support new-hire onboarding and process training.

• Manage attendance, leave, performance issues, and team discipline as required.

• Motivate the team and create a high-performance culture.

• Conduct regular one-on-one discussions and performance reviews.

7. Productivity, Quality & SLA Management

• Monitor and achieve agreed productivity, quality, collection, SLA, and TAT targets.

• Track daily, weekly, and monthly team performance.

• Identify productivity and quality gaps and implement corrective actions.

• Balance productivity with account quality and revenue recovery.

• Ensure timely completion of assigned AR inventory.

• Monitor follow-up effectiveness and account resolution rates.

• Conduct performance reviews and develop action plans for underperforming team

members.

8. AR Aging & Revenue Recovery

• Monitor AR aging and develop strategies to reduce 90+ and 120+ day AR.

• Prioritize high-dollar and high-risk accounts.

• Track recovery performance and identify revenue leakage.

• Analyze payer-wise and denial-wise AR trends.

• Develop focused action plans for aged and difficult accounts.

• Escalate unresolved payer issues through appropriate channels.

• Monitor collection and recovery performance against targets.

9. Quality & Compliance





• Work closely with Quality Analysts to maintain process and call quality.

• Participate in quality calibration sessions.

• Review audit findings and implement corrective actions.

• Ensure compliance with client SOPs, payer guidelines, HIPAA requirements, and

organizational policies.

• Monitor accuracy of claim documentation and account notes.

• Ensure team members follow approved payer communication and escalation procedures.

10. Reporting & MIS

• Prepare and review daily, weekly, and monthly operational reports.

• Monitor key metrics including:

- Productivity
- Quality
- Collection/Recovery
- AR aging

- Denial rate
- Resolution rate
- Call performance
- SLA/TAT
- Inventory
- Attendance

11. Client & Stakeholder Management

• Act as an escalation point for client and internal operational issues.

• Participate in client calls and performance review meetings.

• Communicate operational challenges, trends, and corrective actions.

• Coordinate with QA, Training, Billing, Coding, Payment Posting, and other RCM teams.

• Ensure client-specific requirements and SOPs are communicated and followed by the

team.

• Build strong working relationships with internal and external stakeholders.

12. Process Improvement

• Identify recurring operational and process issues through data analysis and RCA.

• Recommend and implement process improvements to improve collections, quality, and

productivity.

• Identify opportunities to reduce denials and rework.

• Standardize best practices across the team.

• Support automation and technology initiatives where applicable.

• Drive continuous improvement in AR performance and revenue recovery.

Preferred candidate profile

- 6+ years of experience in AR Caller (Physician Billing),Denial Management(Voice)
- And minimum 6 months of experience as Team Lead on Papers.
- Strong experience in Physician Billing / Professional Billing
- Proven experience in AR Calling Voice Process
- Strong Denial Management knowledge
- Excellent understanding of EOB/ERA
- Knowledge of CMS-1500
- Understanding of CPT, HCPCS, ICD-10-CM, and modifiers
- Solid knowledge of US insurance payers
- Experience handling 30/60/90/120+ aging AR
- Strong payer calling and negotiation skills
- Team leadership and people management
- Productivity, quality, SLA, and TAT management
- Excellent analytical and problem-solving skills
- Strong communication and stakeholder-management skills

📌 AR Caller - Physician Billing Team Lead - Vizag (Visakhapatnam)
🏢 Talentboon Consulting
📍 Visakhapatnam