HB AR callers / Hospital Billing AR/ Mumbai/ Ub04 / HB / AR Calling

Job Opening - AR Caller (Hospital Billing) | 1 to 6 Years Experience

Location: Mumbai
Company: Eclat Health Solutions
HR Contact: HR Phani - [phone removed]

Location : Office Address-

Eclat Health Solutions (I) Pvt Ltd

7TH floor of tower 1, Mindspace Juinagar, Plot no Gen 2/1/F,

TTC Industrial Area, Shiravane, Juinagar,

Navi Mumbai, Maharashtra 400705

To Apply: WhatsApp your updated CV to [phone removed]. Please avoid calling. Our HR team will contact shortlisted candidates.

Position: AR Caller - Hospital Billing (UB-04)

Experience Required:

1 - 6 Years in Hospital Billing / Accounts Receivable (AR) / Revenue Cycle Management (RCM)

Roles & Responsibilities

• Follow up on unpaid and denied hospital claims with insurance companies.
• Analyze claim denials, underpayments, and payment variances.
• Review paid claim information and identify reimbursement discrepancies.
• Work on Government and Commercial payers including Medicare, Medicaid, Managed Care, BCBS, Aetna, Cigna, UHC, Humana, etc.
• Handle claim status inquiries, appeals, reconsiderations, and escalations.
• Resolve billing-related issues to maximize collections and reduce AR days.
• Verify eligibility, benefits, coverage limitations, waiting periods, cooling periods, and authorization requirements.
• Research and resolve claim denials related to coding, billing, and payer policies.
• Document account actions accurately in billing systems.

Required Knowledge & Skills

Hospital Billing

• Strong working knowledge of UB-04 Claim Forms.
• Understanding of Type of Bill (TOB) and Revenue Codes.
• Knowledge of DRG (Diagnosis Related Group) reimbursement methodology.
• Experience handling DRG Downgrades and DRG payment disputes.
• Understanding of POA (Present on Admission) indicators.
• Knowledge of 72-Hour Rule and claim bundling regulations.
• Familiarity with Emergency Department CPT Codes.
• Understanding of Professional vs Technical Components.
• Knowledge of Radiology Billing and Coding.

Insurance Concepts

• Medicaid Spend Down knowledge.
• Coordination of Benefits (COB).
• Birthday Rule determination.
• Waiting Period and Cooling Period analysis.
• Coverage verification and benefit investigation.

Payment & Denials

• Experience identifying and resolving:
• Underpayments
• Claim denials
• Claim edits
• Authorization denials
• Medical necessity denials
• Coding denials
• Eligibility denials

Adjustment & Remark Codes

Knowledge of denial and adjustment codes including:

• CO-18 Duplicate Claim/Service
• CO-22 Coordination of Benefits
• CO-50 Medical Necessity Not Met
• CO-197 Precertification/Authorization Required

Coding Knowledge

• Basic ICD-10, CPT and HCPCS understanding.
• Revenue Code validation.
• Modifier usage and reimbursement impact.

Modifier Knowledge

Experience with:

• Modifier 24 – Unrelated E&M During Postoperative Period
• Modifier 25 – Significant Separately Identifiable E&M Service
• Modifier 50 – Bilateral Procedure