Healthcare AR Caller

Key Roles & Responsibilities

Insurance Follow-Up

• Contact insurance companies via phone and payer portals to obtain the status of

outstanding medical claims.

• Follow up on unpaid, underpaid, delayed, and rejected claims.

• Verify claim processing details and payment timelines.

• Ensure prompt reimbursement by maintaining consistent follow-up schedules.

Claim Resolution

• Investigate denied, rejected, or pending insurance claims.

• Identify root causes of claim denials and payment discrepancies.

• Coordinate with insurance representatives to resolve claim-related issues.

• Document claim resolutions accurately in the billing system.

Appeals & Claim Resubmission

• Prepare and submit appeals for denied claims.

• Process corrected claims based on payer requirements.

• Monitor appealed claims until final resolution.

• Ensure compliance with payer-specific appeal guidelines and deadlines.

Patient Account Management

• Review patient accounts for outstanding balances.

• Coordinate with patients regarding payment responsibilities when required.

• Explain billing statements, insurance payments, deductibles, co-payments, and

remaining balances professionally.

Documentation & System Updates

• Accurately document all follow-up activities, payer responses, and claim updates.

• Maintain complete records within the Practice Management (PM) or Electronic

Medical Record (EMR) system.

• Update claim status and account notes after every interaction.

Compliance & Quality Assurance

• Ensure all billing activities comply with HIPAA regulations and healthcare

compliance standards.

• Follow company SOPs, payer policies, and medical billing guidelines.

• Maintain confidentiality of patient health information at all times.

Collaboration

• Work closely with:

o Medical Billing Team

o Payment Posting Team

o Insurance Verification Team

o Coding Team

o Clinical Support Team

• Escalate complex claims to supervisors whenever necessary.

• Participate in team discussions to improve claim recovery processes.

Reporting & Productivity

• Prepare daily and weekly reports on claim follow-ups and account status.

• Monitor aging reports and prioritize high-value outstanding claims.

• Meet productivity, quality, and turnaround time (TAT) targets.

• Contribute to reducing Accounts Receivable aging and increasing collections.