Ar Caller

Roles and Responsibilities

1. Insurance Follow-up (Hospital Claims)

Call insurance companies to check claim status for inpatient & outpatient services

Follow up on high-value hospital claims (ER, surgery, ICU, etc.)

Ensure timely reimbursement for facility charges

2. Denial Management (Facility Side)

Handle denials related to:

Authorization / pre-certification issues

Medical necessity

DRG/APC coding issues

Length of stay (LOS)

Work with coding & clinical teams for corrections

3. AR Aging & Worklist Management

Work on aging reports (30, 60, 90, 120+ days)

Prioritize:

High-dollar claims

Old accounts

Reduce AR days and improve cash flow

4. Payment & Underpayment Analysis

Verify payments received against billed amount

Identify:

Underpayments

Partial payments

Escalate or reprocess claims if needed

5. Claim Re-submission & Appeals

Correct and resubmit denied/rejected claims

File appeals with proper documentation:

Medical records

Discharge summary

Operative notes

6. Authorization & Eligibility Issues

Check if prior authorization was obtained

Resolve eligibility-related denials

Coordinate with front-end/authorization team

7. Coordination with Internal Teams

Work with:

Coding team (ICD, DRG issues)

Billing team

Clinical staff (for medical records)

Escalate complex cases

8. Patient Billing Support (Hospital Accounts)

Assist with patient billing queries

Explain insurance balances, co-pay, deductible

9. Documentation & System Updates

Update call notes in AR systems

Maintain detailed follow-up records

Track claim progress and next actions

10. Compliance & Quality

Follow HIPAA guidelines

Maintain confidentiality of patient data

Ensure accuracy and quality standards