Job Type: Full-Time | Work Mode: Work from Office
Location: Gurugram, Sec 18
We are looking for an experienced AR Denials – Senior Executive with strong expertise in Accounts Receivable (AR) follow-up and Denial Management in the US Healthcare process. The ideal candidate should have a thorough understanding of denial codes and reasons such as No Authorization, Duplicate, Bundled, Inclusive, COB (Coordination of Benefits), and others.
The role requires working directly with insurance companies, healthcare providers, and patients to ensure timely resolution of claims and denial recovery while maintaining compliance with HIPAA standards.
Key Responsibilities:Manage AR follow-up focusing on denial resolution and recovery.
Analyze denials including No Auth, Duplicate, Bundled, Inclusive, COB, Non-Covered, Medical Necessity, Timely Filing, etc.
Contact insurance companies to check claim status, understand denial reasons, and take corrective actions.
Verify accurate insurance details and patient registration data on behalf of clients.
Communicate with clients regarding potential coding, billing, or documentation issues.
Submit claims via billing software (electronic and paper) and ensure accuracy in submissions.
Follow up on unpaid or denied claims within the standard billing cycle timeframe.
Research, resolve, and appeal denied or rejected claims with appropriate supporting documents.
Perform eligibility and benefit verification through web portals or over the phone.
Review patient bills for completeness and accuracy; obtain and rectify any missing information.
Process payments including ERA (Electronic Remittance Advice) and EOB (Explanation of Benefits) posting.
Understand and apply insurance payer policies including HMO, PPO, Medicare, Medicaid, and Commercial plans.
Maintain accurate documentation of all actions in the system.
Ensure compliance with HIPAA and internal quality standards.
Minimum 2 years of hands-on experience in US Healthcare AR follow-up and Denial Management.
Strong understanding of denial types including No Auth, COB, Bundled, Duplicate, Inclusive, and other payer-specific denial reasons.
Knowledge of payer rules, coordination of benefits (COB), and appeals processes.
Familiarity with charge entry, claim submission, and payment posting (ERA/EOB).
Ability to read and interpret superbills and medical billing data.
Strong verbal and written communication skills.
Detail-oriented with the ability to multitask and meet productivity targets.
Familiarity with credentialing is a plus.
Proficient in handling Protected Health Information (PHI) in line with HIPAA compliance.
Be part of a collaborative and growing team.
Competitive compensation and performance-based incentives.
Opportunities for skill development in the healthcare RCM domain.
Stable work environment with a focus on professional growth.
