Key Responsibilities :
- Follow up on outstanding physician/professional insurance claims to ensure timely reimbursement.
- Review, analyze, and resolve denied, rejected, or underpaid claims by identifying the root cause and taking appropriate corrective action.
- Communicate with commercial insurance companies, Medicare, Medicaid, and other payers regarding claim status, payment discrepancies, and reimbursement issues.
- Submit corrected claims, appeals, and supporting documentation in accordance with payer guidelines.
- Review Explanation of Benefits (EOBs) and Electronic Remittance Advice (ERAs) to identify payment variances and denial reasons.
- Perform insurance Eligibility and Benefits Verification (EV/BV) when required.
- Obtain and track Prior Authorizations (PA) for physician services and procedures.
- Coordinate with providers, coding, billing, and front-office teams to resolve claim and documentation issues.
- Monitor aging reports and work assigned AR queues to achieve productivity and collection targets.
- Maintain accurate account notes and documentation in the practice management and billing systems.
- Ensure compliance with HIPAA regulations and payer-specific policies.
Preferred Skills
- Experience in physician/professional medical billing and Accounts Receivable (AR) follow-up.
- Strong knowledge of commercial insurance, Medicare, Medicaid, Managed Care, and other government payers.
- Experience with Prior Authorization (PA) and Eligibility & Benefits Verification (EV/BV) processes.
- Understanding of CPT, ICD-10-CM, and HCPCS coding concepts related to physician billing.
- Experience reviewing EOBs, ERAs, claim denials, appeals, and payment posting issues.
- Familiarity with practice management and EMR/EHR systems such as eClinicalWorks
- Excellent analytical, problem-solving, communication, and payer negotiation skills.
- Proficiency in Microsoft Excel and other Microsoft Office applications.
Experience
- 1–3 years of experience in Accounts Receivable (AR)and denial management in Revenue Cycle Management (RCM).
Pay: ₹10,000.00 - ₹25,000.00 per month
Benefits:
Work Location: In person
