AR Follow-up - RCM (US Healthcare)

Associates own payer follow-up and claim-status resolution on assigned buckets. Senior Associates handle complex denials, appeals, and aged AR, and act as first-line quality support for the pod.

• Work assigned AR buckets — call US payers on claim status, underpayments, and non-payment, and document actions clearly in the billing system.
• Analyze EOBs/ERAs, identify denial reasons (CARC/RARC), and take corrective action — rebill, reprocess, or escalate.
• Meet daily productivity and quality targets (claims worked, resolution rate, call quality).
• Maintain HIPAA-compliant handling of PHI at all times.

• Own complex denials and appeals — draft appeal letters, track appeal TAT, and follow through to overturn.
• Work aged AR (90+/120+) with root-cause notes that feed prevention, not just recovery.
• Support the TL on quality — spot-check documentation, coach new associates on payer-specific nuances.

• Associate: minimum 1 year in US healthcare AR calling (provider side). Sr Associate: 3–4 years with hands-on denials and appeals work.
• Working knowledge of the US revenue cycle — claim lifecycle, EOB/ERA reading, denial codes (CARC/RARC), and timely-filing rules.
• Experience on practice-management / EHR platforms — Epic, AdvancedMD, or Athena Health preferred; similar platforms considered.

• Multi-specialty physician-group experience.
• Exposure to both government (Medicare/Medicaid) and commercial payers.

• Education: Bachelor’s degree (any discipline) is mandatory and must be completed — candidates currently pursuing a degree, or with an incomplete/dropped graduation, are not eligible.
• Communication: Voice-facing role — excellent spoken English with a clear, neutral accent and confident US payer-call handling, plus good written English for accurate documentation.
• Work mode & shift: Onsite at Gurugram, 5 days a week, on a fixed night (US-hours) shift — reliable attendance, punctuality, and roster adherence are essential.
• Systems: Comfortable working in billing/EHR platforms and MS Office; good computer proficiency and clear note-writing.
• Notice period: Immediate joiners or candidates on short notice strongly preferred.

• Claims worked per day (productivity target).
• Resolution / collection rate on assigned buckets.
• Call and documentation quality score (from QA audits).
• Aged-AR (90+/120+) reduction and denial-overturn rate (Sr Associate).

• HR Screening
• 2 Technical Interviews
• Assessment Round
• HR discussion (fitment, shift, salary).