Chennai, Tamil Nadu 4-7 Yrs ₹350000 - ₹700000 Yearly
Job Summary:
The AR Caller will be responsible for following up on outstanding insurance claims and patient balances, focusing on out-of-network provider accounts for a surgical practice. The role involves verifying claim status, resolving denials, and ensuring timely reimbursement while maintaining compliance with payer and practice policies.
Key Responsibilities:
Perform insurance follow-up on unpaid and underpaid claims for out-of-network surgical procedures.
Contact insurance companies via phone, email, or online
portals to determine claim status and resolve payment issues.
Review and analyze EOBs (Explanation of Benefits) and ERAs
(Electronic Remittance Advices) for accuracy.
Handle complex OON claims involving UCR (Usual, Customary,
and Reasonable) charges, balance billing, and appeal processes.
Prepare and submit appeals and reconsiderations for denied
or underpaid claims.
Maintain accurate and detailed documentation of all
communications and actions taken.
Collaborate with billing, coding, and payment posting teams
to ensure clean claims and proper follow-up.
Identify payer trends and recurring issues and escalate to
management when necessary.
Meet or exceed daily productivity and quality metrics (calls
per day, resolution rate, etc.).
Ensure compliance with HIPAA and all relevant regulations
and company policies.
Qualifications & Skills:
Education: High school diploma or equivalent (Bachelors degree preferred).
Experience: 4-6 years of AR calling experience in medical
billing, specifically with out-of-network and surgical claims (orthopedic,
neurosurgery, general surgery, plastic, or pediatric surgery).
Strong understanding of EOBs, CPT/ICD codes, payer
guidelines, and appeal processes.
Knowledge of major insurance carriers (BCBS, Aetna, Cigna,
UHC, etc.) and their OON claim policies.
Experience using practice management systems and
clearinghouses.
Excellent communication and negotiation skills when
interacting with payers.
Strong analytical and problem-solving skills with attention
to detail.
Ability to work independently and meet strict deadlines.
Proficiency with Microsoft Office (Excel, Word) and general
computer literacy.
Preferred Experience:
Prior experience in a surgical billing company or specialty practice (plastic, orthopedic, neurosurgery, or pediatric surgery).
Familiarity with balance billing regulations and
out-of-network appeal strategies.
Understanding of state-specific OON reimbursement laws and
payer-specific OON policies.