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

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

RevUpside Business Solutions Private LimitedNavi Mumbai, Maharashtra, India
6 days ago
Job description

Key Responsibilities for AR :

  • Review account thoroughly, including any prior comments on the account, EOBs / ERAs / Correspondence, and perform pre-resolution analysis.
  • Understand the reason for rejection, denials, or no status from the payer.
  • 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.
  • 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.
  • Documentation of all the actions on the practice management system and workflow management system, and maintain an audit trail.
  • Ensure adherence to Standard Operating Procedures and compliance.
  • Highlight any global trend / pattern and issue escalation with the leadership team.
  • Meet the productivity and quality target on a daily / monthly basis.
  • Upskill by learning new / additional skills and enhancing competencies. Active participation in all process / client-specific training and refresher training.

Requirements :

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

    • Key Responsibilities for EVBV :

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

    • Requirements :

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

    • Key Responsibilities for Authorization :

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

    • Requirements :

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