US Healthcare RCM Hiring || AR Caller | Prior Authorization || EVBV ||

AR Caller (Accounts Receivable Caller)

Responsibilities:

• Call insurance companies (payers) to follow up on pending/unpaid claims.
• Analyze and resolve denied/rejected claims through appropriate action.
• Maintain calling quality and productivity standards.
• Document the outcome of calls and update systems accurately.

Required Skills:

• Excellent verbal communication in English.
• Knowledge of CPT, ICD, Modifiers, and claim life cycle is a plus.
• Experience in denial management or payer follow-up preferred.

2. Prior Authorization Executive

Responsibilities:

• Initiate and obtain prior authorizations from insurance companies for procedures or services.
• Coordinate with physicians and clinical teams to gather documents.
• Use payer portals or phone to track, follow up, and update auth status.
• Ensure authorizations are completed within TAT.

Required Skills:

• Good understanding of insurance processes and CPT codes.
• Prior experience in auth submissions via Availity, Navinet, etc., preferred.
• Strong coordination and documentation skills.

3. Eligibility & Benefits Verification (EVBV) Executive

Responsibilities:

• Verify patient insurance eligibility and benefit coverage via portals or calls.
• Confirm policy status, active coverage, co-pay, deductible, and service-specific eligibility.
• Record accurate benefit information and escalate discrepancies if needed.
• Support front-office/pre-authorization teams with timely verifications.

Required Skills:

• Strong attention to detail and understanding of payer terminologies.
• Experience in using tools like Availity, Navinet, or payer websites is a plus.
• Excellent communication and documentation skills.