Key Responsibilities for AR:
- Review account thoroughly, including any prior comments on the account, EOBs / ERAs / Correspondence, and perform pre-resolution analysis.
- Understand the reason for rejection, denials, or no status from the payer.
- Work on the resolution of the claim by performing follow-up with the payer using the most optimal method, i.e., calling, IVR, web, or email.
- Take appropriate action to move the account towards resolution, including rebilling the claim, sending claims for reprocessing, reconsideration, redetermination, appeal (portal/web, fax, mail), verifying eligibility and benefits, and managing management hand-off with the client and internal teams.
- Documentation of all the actions on the practice management system and workflow management system, and maintain an audit trail.
- Ensure adherence to Standard Operating Procedures and compliance.
- Highlight any global trend/pattern and issue escalation with the leadership team.
- Meet the productivity and quality target on a daily/monthly basis.
- Upskill by learning new/additional skills and enhancing competencies. Active participation in all process/client-specific training and refresher training.
Requirements:
- Undergraduate / Graduate in any stream with 2 to 4 years of experience in US Healthcare RCM for Account Receivable / Denial Management Resolution.
- Fluent communication, both verbal and written.
- Good analytical skills, attention to detail, and resolution-oriented.
- Should have knowledge about the RCM end-to-end cycle and proficiency in AR fundamentals and denial management.
- Basic knowledge of computers and MS Office.
Key Responsibilities for EVBV:
- Review and verify patient insurance coverage, eligibility, and benefits prior to appointments or claim submission.
- Conduct insurance verification through payer websites, IVR systems, or direct calls to insurance companies.
- Accurately document insurance benefits, co-pays, deductibles, co-insurance, and coverage limitations in the practice management system.
- Identify discrepancies or inactive policies and escalate or resolve them as appropriate.
- Maintain up-to-date knowledge of insurance plans, benefit structures, and payer guidelines.
- Ensure timely and accurate completion of verifications as per client SLA or daily targets.
- Adhere to Standard Operating Procedures (SOPs) and compliance guidelines.
- Escalate payer-related issues, trends, or delays to team leads or management.
- Participate in client-specific training and continuous upskilling programs.
Requirements:
- Undergraduate / Graduate in any stream with 1 to 3 years of experience in US Healthcare RCM, specifically in Eligibility & Benefits Verification.
- Strong communication skills (verbal and written) with clarity and professionalism during payer calls.
- Proficient in working with payer portals, IVR systems, and MS Office tools.
- Basic understanding of insurance terminology (e.g., HMO, PPO, deductible, co-pay, out-of-network).
- Ability to work under deadlines with strong attention to detail and accuracy.
- Knowledge of the end-to-end RCM process and patient access cycle is preferred.
