Senior Ar Caller

Job Summary:

We are seeking an experienced Senior Process Executive to oversee Revenue Cycle Management(RCM) process, including addressing eligibility and benefits, insurance claim backlogs, denials, and Accounts Receivable (AR) follow-up. The ideal candidate will have a proven track record in eligibility and benefits management, authorization management, claims management and process improvement. This role will require a focus on operational excellence, data-driven decision-making, and fostering a culture of accountability within the team.

Roles and Responsibilities

• Work Accountabilityo Responsible for addressing RCM insurance claim backlogs, including denials and ARfollow-up.o Foster a culture of accountability, efficiency, and continuous improvement.o Conduct regular performance evaluations and implement training initiatives toenhance team skills.o Must have worked on Eligibility Verification, Claims Management, Denialmanagement and appeals.o Must maintain accountability and work towards resolution of the claim.• Operational Excellence in Claims Managemento Drive the resolution of Active Outstanding claims by implementing effectiveprioritization and workflows.o Ensure Total Failed claims remain at minimum levels, utilizing analytics and proactiveinterventions.o Oversee the resolution of aged claims, maintaining Accounts Receivable >120 daysat or below 5%.o Develop and implement policies, procedures, and best practices for claimsprocessing and denial management.o Ensure to complete the target and go beyond every day to improve daily collections.

Key Performance Indicators (KPIs)

• Active Denied/No Response claims resolved daily (target: 50).• Work on all denied claims within 48 hours towards resolution.• A/R >120 days maintained at or below 5% and A/R > 90 days maintained below 15%.• Claim denial rates maintained below 5%.• Net Collection Rate (NCR) sustained at 95% or higher.

Qualifications

• Any Bachelors degree preferred.• Minimum of 3+ years of experience in revenue cycle management, with a proven trackrecord in managing insurance claims, backlogs, authorizations, eligibility and denials.• Extensive knowledge of healthcare billing, coding, and reimbursement processes.• Strong work management skills, with experience managing large, diverse clients.• Proficiency in RCM software, data analytics tools, and advanced Excel functions.• Exceptional problem-solving skills and attention to detail.• Outstanding communication and organizational skills, with the ability to manage multiplepriorities effectively.• Willing to work on night shifts (US Timings)