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 US health care industry (HB or PB – HB preferred).
Ability to read and interpret 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.
Credential and Enrollment
Process – Credentialing
Designation: Credentialing and Enrollment Specialist