The RCM Sector's Development Path for AR Callers

The RCM Sector's Development Path for AR Callers Job Description In order to settle unpaid or rejected medical claims, the Accounts Receivable (AR) Caller is in charge of contacting commercial and government insurance providers. Your main objective is to speed up healthcare providers' cash flow by figuring out why a claim hasn't been paid and taking the required steps to get the money back. A strong grasp of the U.S. healthcare revenue cycle, a persistent "investigative" mindset, and the capacity to successfully bargain with insurance adjusters are all necessary for this position. A meticulous expert who can manage a large volume of calls and navigate intricate insurance websites while maintaining a high collection rate is the ideal candidate. Responsibilities Claims Follow-up: Make proactive calls to insurance companies (payers) about unpaid claims that are past the typical 30- to 45-day payment timeframe. Denial Management: To determine the underlying reason for claim denials, examine "Electronic Remittance Advice" (ERA) and "Explanation of Benefits" (EOB). Appeals Processing: Write formal appeal letters, supported by the required medical records, and send them to insurance companies for claims that were unfairly refused. Insurance Portals: To check claim status, member eligibility, and benefit details without making a phone call, use web-based payer portals. Patient Interaction: Give patients a call to get information about their insurance or to emphasize that they are responsible for paying for the services they receive. Data Logging: In the Billing System/CRM, accurately record every interaction with insurance representatives, including the representative's name, call reference number, and anticipated payment date. Skills: US Healthcare Knowledge: Excellent knowledge of Medicare/Medicaid, HIPAA rules, and various plan types (HMO, PPO, EPO). Communication & Negotiation: Strong verbal English communication skills; the capacity to deal with insurance adjusters in a firm yet professional manner. Analytical Skills: The capacity to decipher EOBs and spot patterns in payer behavior. High typing speed and the capacity to switch between several software displays are features of typing and navigation (Billing Software, Excel, Payer Portals). We invite you to apply and explore this exciting opportunity! Warm Regards, HR - Maria