Sr. Ar Caller

Position:

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Interested candidates send your cv to shane@parkmedicalbilling.com

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.