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 solid 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
- Strong 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