Black And White Business Solutions is seeking a skilled AR Caller - Denial Management to join our team. This role is crucial for managing and resolving insurance claim denials efficiently. The ideal candidate will have a strong understanding of denial reasons and appeal processes, coupled with excellent communication and problem-solving skills, to ensure maximum revenue recovery and seamless operations.

Must Have Skills

Experience as an AR Caller in Denial Management: Proven background in Accounts Receivable (AR) calling, specifically focused on the resolution of denied claims.
Good understanding of denial reasons (CO, OA, PR codes) and appeal processes: In-depth knowledge of common denial codes (Contractual Obligation, Other Adjustments, Patient Responsibility) and the ability to navigate complex appeal procedures.
Familiarity with healthcare insurance terminology, CPT/ICD coding basics: Basic understanding of terms used in healthcare insurance and foundational knowledge of CPT (Current Procedural Terminology) and ICD (International Classification of Diseases) coding.
Strong analytical and problem-solving skills: Ability to thoroughly analyze denied claims, identify root causes, and develop effective strategies for resolution.
Excellent communication skills (both verbal and written): Clear and professional communication to interact effectively with insurance companies and document interactions.
Proficiency in working with RCM software/tools like EPIC, Athena, eClinicalWorks, etc.: Hands-on experience with popular Revenue Cycle Management (RCM) software and tools to manage claims and denials.
Typing speed of at least 30 WPM with accuracy: Efficient typing skills to ensure quick and accurate data entry and documentation.
Ability to multitask and meet deadlines under pressure: Capability to handle multiple denied claims simultaneously and ensure timely resolution within set targets.

Good to Have Skills

Knowledge and expertise in AR Caller in Denial Management: Comprehensive understanding and advanced proficiency in the processes and best practices related to AR calling for denial management.

Roles and Responsibilities

Review and analyze insurance claim denials from various payers, understanding the specific reasons for denial.
Make outbound calls to insurance companies to proactively resolve denied or unpaid claims, advocating for appropriate reimbursement.
Identify the root cause of denials (e.g., coding errors, eligibility issues, authorization lapses, medical necessity), performing detailed investigations.
Take appropriate actions such as preparing and filing appeals, making necessary claim corrections, or rebilling claims to ensure proper processing.
Document all activities accurately in the client system or internal tools, maintaining clear and concise records of interactions and resolutions.
Follow-up on pending claims within the specified Turnaround Time (TAT), ensuring consistent progress towards claim resolution.
Communicate effectively with insurance representatives and escalate complex issues to supervisors or other departments when needed, ensuring timely attention to challenging cases.
Work collaboratively with internal teams (such as coding and billing) to identify and resolve recurring denial trends, contributing to process improvements.
Stay updated with payer-specific guidelines and industry regulations (e.g., HIPAA compliance) to ensure all denial management activities adhere to current standards.

Qualification

Any Graduate and Undergraduate

CTC Range

3 to 4.8 LPA (Lakhs Per Annum)

Notice Period

Immediate

Interview Mode

Virtual

Contact: Amala Subject Matter Expert Black and White Business Solutions Pvt Ltd Bangalore, Karnataka, INDIA. Direct Number: 080-67432406 Email: [HIDDEN TEXT] | Website: www.blackwhite.in

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