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

RevUpside Business Solutions Private Limited · India

• 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.