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