Accounts Receivable Caller

We are looking for a detail-oriented and results-driven AR Caller with experience in US healthcare and hospital billing. The candidate will be responsible for following up on outstanding insurance claims, contacting insurance companies to determine claim status, resolving claim denials, and ensuring timely reimbursement for hospital services.

The ideal candidate should have a good understanding of hospital billing workflows, insurance payer guidelines, denial management, and accounts receivable follow-up processes.

Key Responsibilities

• Perform outbound calls to insurance companies to follow up on outstanding hospital claims.
• Check claim status, payment details, denial reasons, and reimbursement timelines.
• Follow up on unpaid, underpaid, rejected, and denied claims.
• Analyze Explanation of Benefits (EOB) and Electronic Remittance Advice (ERA) to understand payment discrepancies.
• Identify denial reasons and coordinate appropriate corrective actions.
• Work on claim resubmissions, reconsiderations, and appeals as per payer guidelines.
• Verify patient demographics, insurance details, authorization requirements, and claim submission information when needed.
• Follow up on claims related to inpatient, outpatient, emergency room, and other hospital services.
• Maintain accurate account notes and document all payer interactions in the billing system.
• Escalate complex denials, coding-related issues, authorization issues, and billing discrepancies to the appropriate teams.
• Meet daily productivity, quality, collection, and turnaround-time targets.
• Ensure compliance with HIPAA requirements and company policies while handling protected health information (PHI).
• Identify recurring denial trends and support process improvement initiatives.

Required Skills and Qualifications

• Minimum 1-3 years of experience in US healthcare AR calling or medical billing, preferably hospital billing.
• Knowledge of the US healthcare revenue cycle management (RCM) process.
• Understanding of hospital claims, including inpatient and outpatient billing.
• Familiarity with insurance payers, claim status inquiries, denial management, and appeals.
• Knowledge of EOB, ERA, EDI claims, and common claim adjustment and denial codes.
• Good verbal communication and professional telephone etiquette.
• Strong analytical, problem-solving, and follow-up skills.
• Ability to manage high-volume accounts and meet productivity targets.
• Basic computer skills and familiarity with medical billing software or practice management systems.

Preferred Qualifications

• Experience with Medicare, Medicaid, and commercial insurance payers.
• Knowledge of UB-04/CMS-1450 institutional billing and CMS-1500 professional billing.
• Familiarity with payer portals, clearinghouses, and electronic claim submission.
• Understanding of denial codes such as CO-16, CO-18, CO-29, CO-45, and PR-1.
• Experience with hospital billing systems and RCM platforms.