- Claim Follow-Up: Call insurance companies, check the status of pending/outstanding claims via phone, IVR, or web portals, and track aging receivables.
- Denial Management: Investigate, analyze, and resolve rejected, underpaid, or denied claims.
- Appeals &
- Resubmissions:
Correct billing or coding errors, prepare and submit appeals, and request Reprocessing or Explanation of Benefits (EOB) documents.
- Documentation &
- Auditing:
Record detailed notes of all payer interactions, call reference numbers, and follow-up actions inside practice management or billing software.
- Coordination: Work alongside medical coders, billing teams, and client representatives to fix root-cause errors and lower accounts receivable (AR) days.
- Patient &
- Payer Communication:
Address patient billing inquiries or transfer balances when insurance coverage is exhausted or unavailable.
Key Skills &
- Requirements
- Industry Knowledge:
Understanding of the end-to-end U.S.
Healthcare Revenue Cycle
Management (RCM) lifecycle, CPT/ICD-10 coding basics, and HIPAA compliance.
- Communication &
- Negotiation:
Explicit verbal and written English communication skills to negotiate maximum reimbursement with insurance representatives.
- Technical Proficiency: Experience with Electronic Health Record (EHR) / Practice Management (PM) systems, insurance payer portals, and Excel.
- Experience Level: Ranging from freshers (with paid training or voice process orientation) to experienced executives with 1 to 5+ years in medical billing or denial management.