01Key Responsibilities
Perform insurance follow-ups on unpaid, underpaid, and denied claims.
Work on aging buckets (60+/90+/120+ AR) and reduce outstanding balances.
Analyze denial codes (CO-97, CO-45, CO-18, CO-50, CO-197) and take appropriate action (Appeal / Rebill / Adjustment).
Draft and submit strong appeals with required documentation.
Follow up on high-value and escalated accounts.
Interpret EOBs/ERAs accurately and identify payment discrepancies.
Ensure timely filing compliance and adherence to payer guidelines.
Accurately document call notes and account updates in the system.
Coordinate with Posting, Coding, and Eligibility teams for issue resolution.
Maintain productivity and quality standards as per SLA.
Adhere to HIPAA regulations and company policies.
Stay updated on payer updates and industry regulations.
Qualifications:36 years of experience in US Healthcare AR / Denial Management.
Strong understanding of Medicare, Medicaid, and Commercial insurance.
Expertise in EOB/ERA interpretation and managed care guidelines.
Knowledge of Timely Filing Limits (TFL) and appeals process.
Proficiency in Microsoft Office Suite (Excel preferred).
Excellent communication and analytical skills.
Strong attention to detail and ability to handle escalations independently.
Ability to work night shifts and from the office. .
