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

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.