AR Callers & Denial Management, EVBV, Authorization Specialists - (Medical Billing)

Key Responsibilities for AR:

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• Review account thoroughly, including any prior comments on the account, EOBs / ERAs / Correspondence, and perform pre-resolution analysis.
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• Understand the reason for rejection, denials, or no status from the payer.
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• Work on the resolution of the claim by performing follow-up with the payer using the most optimal method, i.e., calling, IVR, web, or email.
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• Take appropriate action to move the account towards resolution, including rebilling the claim, sending claims for reprocessing, reconsideration, redetermination, appeal (portal/web, fax, mail), verifying eligibility and benefits, and managing management hand-off with the client and internal teams.
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• Documentation of all the actions on the practice management system and workflow management system, and maintain an audit trail.
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• Ensure adherence to Standard Operating Procedures and compliance.
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• Highlight any global trend/pattern and issue escalation with the leadership team.
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• Meet the productivity and quality target on a daily/monthly basis.
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• Upskill by learning new/additional skills and enhancing competencies. Active participation in all process/client-specific training and refresher training.
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Requirements:

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• Undergraduate / Graduate in any stream with 2 to 4 years of experience in US Healthcare RCM for Account Receivable / Denial Management Resolution.
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• Fluent communication, both verbal and written.
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• Good analytical skills, attention to detail, and resolution-oriented.
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• Should have knowledge about the RCM end-to-end cycle and proficiency in AR fundamentals and denial management.
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• Basic knowledge of computers and MS Office.
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Key Responsibilities for EVBV:

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• Review and verify patient insurance coverage, eligibility, and benefits prior to appointments or claim submission.
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• Conduct insurance verification through payer websites, IVR systems, or direct calls to insurance companies.
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• Accurately document insurance benefits, co-pays, deductibles, co-insurance, and coverage limitations in the practice management system.
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• Identify discrepancies or inactive policies and escalate or resolve them as appropriate.
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• Maintain up-to-date knowledge of insurance plans, benefit structures, and payer guidelines.
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• Ensure timely and accurate completion of verifications as per client SLA or daily targets.
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• Adhere to Standard Operating Procedures (SOPs) and compliance guidelines.
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• Escalate payer-related issues, trends, or delays to team leads or management.
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• Participate in client-specific training and continuous upskilling programs.
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Requirements:

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• Undergraduate / Graduate in any stream with 1 to 3 years of experience in US Healthcare RCM, specifically in Eligibility & Benefits Verification.
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• Strong communication skills (verbal and written) with clarity and professionalism during payer calls.
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• Proficient in working with payer portals, IVR systems, and MS Office tools.
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• Basic understanding of insurance terminology (e.g., HMO, PPO, deductible, co-pay, out-of-network).
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• Ability to work under deadlines with strong attention to detail and accuracy.
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• Knowledge of the end-to-end RCM process and patient access cycle is preferred.
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Key Responsibilities for Authorization:

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• Review patient and procedure details to determine if prior authorization is required based on payer policies.
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• Obtain authorizations by submitting complete and accurate information through payer portals, fax, or direct calls.
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• Understand and follow payer-specific authorization guidelines and timelines.
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• Track and follow up on pending authorization requests and escalate issues if needed.
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• Ensure timely documentation of authorization numbers, approval dates, and denial reasons in the practice management system.
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• Communicate with providers, patients, and internal teams regarding authorization status and requirements.
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• Respond to reauthorization requests or additional information required by payers.
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• Maintain compliance with HIPAA and payer-specific regulations.
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• Stay updated with changes in authorization requirements and payer-specific guidelines.
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• Meet daily/weekly targets for authorization submissions and follow-ups.
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• Participate actively in team meetings, training sessions, and process improvements.
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Requirements:

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• Undergraduate / Graduate in any stream with 1 to 3 years of experience in US Healthcare RCM, specifically in Authorization Management.
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• Experience in submitting and managing authorization requests via insurance portals, fax, or telephonic communication.
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• Sound knowledge of payer-specific requirements for different specialties (e.g., radiology, DME, sleep studies, surgeries, etc.).
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• Excellent communication skills (both verbal and written), especially for handling payer calls.
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• Familiarity with documentation and record-keeping in EHR/EMR or RCM systems.
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• Basic proficiency in MS Office and navigating web-based payer platforms.
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