Accounts Receivable Caller

Qzigma Technologies is looking for a skilled and detail-oriented Accounts Receivable (AR) Caller to join our Medical Billing team. The ideal candidate should have hands-on experience in Accounts Receivable, Prior Authorization (PT), Eligibility & Benefits Verification, and healthcare revenue cycle management. The candidate will be responsible for following up with insurance companies regarding outstanding claims, resolving denials, and ensuring timely reimbursement.

Note: Experience in Prior Authorization and Eligibility & Benefits Verification must be clearly mentioned in the CV.

Key Responsibilities

Accounts Receivable Management

• Review and analyze unpaid, denied, or underpaid insurance claims.
• Follow up with insurance companies through calls and payer portals to ensure timely claim resolution.
• Investigate claim denials and identify the root cause of payment delays.
• Work on aging reports and prioritize high-value outstanding accounts.

Prior Authorization & Verification

• Perform Prior Authorization (PA) activities for medical procedures and treatments.
• Conduct Eligibility and Benefits Verification before claim submission.
• Coordinate with insurance providers to obtain required approvals and authorizations.

Claims Resolution

• Resolve denied, rejected, and pending claims by communicating with insurance representatives.
• Ensure accurate documentation of claim status and follow-up actions.
• Escalate complex issues when necessary and track them through resolution.

Documentation & Reporting

• Maintain complete and accurate records of payer interactions.
• Update billing systems, AR reports, and claim management tools.
• Prepare daily productivity and status reports.

Compliance & Quality

• Follow HIPAA guidelines and healthcare industry regulations.
• Ensure confidentiality of patient information and billing records.
• Adhere to client-specific processes and quality standards.

Required Qualifications

• 1 to 6 years of experience in Medical Billing, Revenue Cycle Management, or AR Calling.
• Hands-on experience in:
• Accounts Receivable (AR) Calling
• Prior Authorization (PT)
• Eligibility & Benefits Verification
• Good understanding of US Healthcare, Medical Billing, and Insurance Processes.
• Knowledge of claim lifecycle, denials management, and reimbursement processes.
• Familiarity with CPT, ICD, HCPCS codes, and medical terminology.
• Strong verbal communication and negotiation skills.
• Ability to analyze EOBs, ERAs, and denial reasons.
• Proficiency in MS Office and healthcare billing software.

Preferred Skills

• Experience with physician billing or hospital billing processes.
• Strong problem-solving and analytical abilities.
• Ability to work under pressure and meet productivity targets.
• Excellent organizational and time management skills.
• Team-oriented mindset with strong attention to detail.