Job Title: AR Associate – Denials Processing / Claims Follow-up / Customer Service
Department: Accounts Receivable (AR) / Healthcare Operations
Reporting To: AR Supervisor / Team Lead
Role Description Overview:
The AR Associate is responsible for managing day-to-day activities related to Denials Processing, Claims Follow-up, and Customer Service. This role involves reviewing updates, communicating with insurance carriers, documenting actions taken, and ensuring compliance with client-specific requirements and standards. The AR Associate plays a crucial role in ensuring that the targeted collections are met, claims are followed up on effectively, and accurate status reports are maintained.
Key Responsibilities:
Denials Processing & Claims Follow-Up:
Review emails for updates on claims and denials.
Call insurance carriers to follow up on denied claims, ensuring proper documentation of notes in software and spreadsheets.
Take appropriate actions based on the status of claims and ensure timely resolution.
Identify and escalate issues related to denials to the immediate supervisor for further analysis and resolution.
Documentation & Reporting:
Document all actions taken, including communication with insurance carriers and follow-up procedures.
Update production logs and maintain detailed records of all claim-related activities.
Prepare and maintain status reports on claims, denials, and productivity, ensuring the timely delivery of information.
Client Specifications & Productivity Targets:
Understand and adhere to client requirements and specifications for claims processing.
Ensure that targeted collections are met on a daily and monthly basis by following up on pending claims and ensuring timely resolution.
Ensure that the productivity targets set by clients are met within the stipulated timeframes.
Quality Assurance:
Ensure all deliverables to the client adhere to quality standards, including accuracy, timeliness, and compliance with client specifications.
Follow up on pending claims, ensuring the correct actions are taken for resolution.
Customer Service:
Provide high-quality customer service to clients, addressing any queries related to claims status, denials, and payment follow-up.
Communicate effectively with insurance carriers and clients to resolve any issues or delays in processing claims.
Desired Profile:
Experience:
Previous experience in accounts receivable, claims processing, or customer service, preferably in a healthcare or insurance environment.
Skills and Competencies:
Strong understanding of the claims follow-up process, including insurance denial management.
Excellent communication skills (both verbal and written).
Attention to detail with the ability to accurately document and track claim activities.
Ability to identify issues and escalate them effectively.
Proficiency in using healthcare software and spreadsheets for documentation and reporting.
Education:
Any relevant educational background (preferably in healthcare or finance).
Certifications:
Relevant certifications in healthcare administration or claims processing are a plus.
Shift Details:
General Shift / Day Shift
Work Mode:
Work From Office (WFO)
This role is ideal for individuals who have a strong understanding of claims management, enjoy resolving denials, and thrive in a fast-paced, client-focused environment. The AR Associate will play a key role in ensuring that claims are processed effectively and efficiently, contributing to the overall success of the organization.
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