An A/R representative is responsible for timely and accurate follow-up and appeal of denials/rejections received from third-party payers. The representative will manage their assigned work to ensure payer appeal/filing deadlines are met and achieve optimal payment for services rendered.
• Graduate with 1-5 years’ experience in the US health care industry (HB or PB – HB preferred).
• Ability to read and interpret the insurance explanation of benefits (EOBs
• Knowledge of payer edits, rejections, rules, and how to appropriately respond to each.
• Accuracy in identifying the cause of rejections/denials and selecting the most appropriate method for resolution.
• Demonstrated proficiency with timely and successful appeals to insurance companies
• Should have excellent communication skills and the ability to remain pleasant during difficult conversations regarding outstanding bills or debts.
• Should have knowledge on terms like CPTs, Modifiers, and ICD code
• Should have knowledge on insurance guidelines especially Medicare and Non-Medicare.
• Must possess excellent communication and interpersonal skills to work well with patients and claims rep.