Executive - AR and Senior Executive - AR

Job description

ob Summary We are seeking a detail-oriented and result-driven physician Billing AR Executive to manage accounts receivable activities for physician and professional claims. The candidate will be responsible for analyzing unpaid claims, resolving denials, following up with insurance companies, and ensuring timely reimbursement while adhering to payer guidelines and client requirements. Key Responsibilities • Review and analyze unpaid, denied, and underpaid professional claims. • Follow up with insurance payers through calls and payer portals regarding claim status. • Investigate claim denials and take appropriate corrective actions for resolution. • Submit appeals, reconsiderations, and supporting documentation as required. • Verify patient eligibility, benefits, authorization, and claim adjudication details. • Work on denial management including CO-50, CO-96, CO-197, CO-198, PR-1, PR-227, and other payer-specific denials. • Identify trends in denials and escalate recurring issues to the leadership team. • Ensure compliance with HIPAA regulations and client-specific processes. • Meet productivity, quality, and turnaround time (TAT) targets. • Maintain accurate documentation of follow-up actions in the billing system. • Collaborate with internal departments to resolve billing and coding-related issues. Required Skills • Good understanding of US Healthcare Revenue Cycle Management (RCM). • Knowledge of Professional Billing (Physician Billing) workflows. • Familiarity with Medicare, Medicaid, Commercial, PPO, HMO, and Managed Care plans. • Strong knowledge of denial management and appeals process. • Ability to interpret EOBs, ERAs, and remittance advice. • Excellent communication and analytical skills. • Proficiency in MS Excel and billing software. Qualification • Graduate in any discipline. • 1-5 years of experience in Professional Billing AR / Physician Billing AR. • Experience in handling insurance follow-up and denial management. Location: Chennai Shift: US Shift / Night Shift HR -Malini B 8825476278 Malini.b@omegahms.com