AR Appeals & Credentialing Specialist

About the Role

HANR Support Services Pvt. Ltd., established in July 2023, provides comprehensive solutions including operational support, skilled nursing care, billing and full revenue cycle management, and prior authorization services to healthcare providers. This position is based in Sakinaka (Andheri East), Mumbai, and follows a Monday to Friday schedule with weekends off, working US night shifts.

Key Responsibilities

• Analyze accounts receivable (AR), aging reports, denial reports, and payer-specific workloads to manage denied, underpaid, and outstanding insurance claims.
• Investigate reasons behind denial, rejection, or underpayment of claims by reviewing Explanation of Benefits (EOBs), Electronic Remittance Advices (ERAs), denial codes, and payer communications.
• Implement solutions such as claim corrections, reprocessing, reconsiderations, or appeals, ensuring submissions are timely and supported by necessary documentation according to payer deadlines.
• Engage regularly with insurance payers via phone, portals, email, and written correspondence to track claim status and resolve disputes, documenting all relevant details meticulously.
• Identify discrepancies in payments versus expected or contracted amounts and escalate recurrent or complex payer issues to management, collaborating with billing and other operational teams for resolution.
• Support provider credentialing and enrollment processes with commercial and government payers by preparing applications, monitoring status via portals, and managing credentialing documentation such as CAQH profiles, NPI numbers, licenses, DEA certificates, and board certifications.
• Handle new provider enrollments, additions to existing contracts, demographic updates, payer revalidations, and maintain records reflecting enrollment status and effective dates.
• Address credentialing-related AR denials by investigating root causes and coordinating corrective actions with billing and credentialing departments to prevent repeated claim impacts.
• Maintain comprehensive, accurate notes and update related RCM, billing, credentialing, and payer systems promptly, ensuring compliance with internal and external policies.
• Meet predefined metrics regarding productivity, quality, turnaround times, and resolution efficiency.

Required Qualifications and Skills

• Proficient English communication skills with a neutral accent.
• A minimum of 13 years experience in US healthcare revenue cycle management, specifically in AR appeals, denial resolution, or credentialing.
• Strong knowledge of US healthcare insurance, medical billing processes, and related coding systems such as CPT, HCPCS, ICD.
• Understanding of EOBs, ERAs, denial codes, claim lifecycle, and familiarity with Medicare, Medicaid, and commercial insurance payers.
• Experienced in AR activities including appeals, reconsiderations, underpayment investigations, and denial management.
• Insight into provider credentialing, payer enrollment procedures, and familiarity with regulatory requirements like CAQH, NPI, and provider participation details.
• Comfortable working with payer portals such as Availity, NaviNet, and other proprietary platforms.
• Experience using EHR/RCM software such as Tebra/Kareo, Wellfuse, Athena, eClinicalWorks, EPIC, or similar systems.
• Proficient with Microsoft Office Suite including Outlook, Teams, Excel, Word, and PowerPoint.
• Ability to adhere to strict deadlines and requirements through thorough research into payer policies.

Desired Attributes

• Analytical mindset with strong problem-solving capabilities.
• Exceptional attention to detail ensuring accuracy in work outputs.
• Capability to juggle multiple cases, appeals, and credentialing requirements efficiently.
• Excellent organizational and follow-up skills.
• Independent work ethic with commitment to meeting productivity and quality standards.
• Professional demeanor in interactions with payers and internal teams.
• Capacity to thrive in a fast-paced, deadline-oriented environment.
• Team player with focus on compliance and optimal revenue cycle outcomes.

Additional Information

This role operates on US night shift timings, Monday through Friday, with weekends off. Candidates must be comfortable working in these hours.

Eligibility

Candidates holding any graduate degree are eligible to apply.