Accounts Receivable Associate

AR Caller & Denial Management Revenue Cycle Management (RCM)

Position Summary

The AR Caller & Denial Management Executive is responsible for following up on unpaid and denied medical claims with insurance companies to ensure timely and maximum reimbursement. The role involves claim analysis, denial resolution, payer communication, and adherence to healthcare billing regulations.

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Key Responsibilities

Accounts Receivable (AR) Follow-up

• Follow up on outstanding insurance claims with payers (Commercial, Medicare, Medicaid).
• Contact insurance companies via calls, portals, and emails to check claim status.
• Work on aging AR buckets (30/60/90/120+ days).
• Ensure timely reprocessing, re-submission, or appeals of claims.
• Identify underpayments and initiate recovery actions.

Denial Management

• Analyze claim denials and rejections using EOBs/ERAs.
• Identify root causes of denials (coding, eligibility, authorization, timely filing, medical necessity, bundling, etc.).
• Correct errors and resubmit claims with accurate coding and documentation.
• Prepare and submit appeals within payer timelines.
• Maintain a denial log and track trends for prevention.
• Collaborate with coding, charge entry, and front-end teams to reduce repeat denials.

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Required Skills & Competencies

• Strong knowledge of US Healthcare Revenue Cycle Management.
• Understanding of CPT, ICD-10, HCPCS, modifiers, and billing rules.
• Familiarity with payer policies, LCD/NCD guidelines.
• Excellent verbal and written communication skills.
• Ability to negotiate and explain claim issues to insurance representatives.
• Strong analytical and problem-solving skills.
• Experience with billing software, payer portals, and clearinghouses.

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Education & Experience

• Graduate or equivalent qualification.
• 14 years of experience in AR follow-up and denial management.
• Experience handling US insurance calls preferred.

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Key Performance Indicators (KPIs)

• Reduction in AR aging
• Denial resolution TAT
• Collection percentage
• Appeal success rate
• First-pass resolution rate
• Productivity (calls/claims handled per day)

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Compliance & Quality

• Ensure compliance with HIPAA and payer regulations.
• Maintain accurate documentation and audit-ready records.
• Adhere to organizational quality and productivity standards.

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