ASHOK REDDY NAGARLA

AR CALLER RULES AND RESPONSIBILITIES:-

• As AR representative responsibilities include, Resolving the Clearing house rejections, and insurance denials, reviewing preparing and pre-submission reports, and Auto post-charge verification.
• Making the Outbound calls to US insurance companies to resolve the denials as well as payment issues (EOB/ERA).
• Daily interaction with the client liaisons, conveying the client requirements to the team with regard to the process.
• Made strategies and workflow for myself to fix the denials as per the reason for the denial.

CLAIMS HANDLER:-

• Followed up on all client requests and verified resolution.
• Provided claims advice to clients, managing expectations and explaining claims processing timelines.
• Escalated critical claims or complex situations to the supervisor for review.
• Handled all claims and communications within established service-level agreements.
• Understanding the provider of health insurance claim cycle.
• Processing of health insurance claims for providers.
• We process health insurance claims for various age groups and types of diseases.
• We send the claims to the payment team to pay as per their insurance plan type after applying deductible, copayment, and coinsurance.
• Escalating claims to other teams and onshore people sometimes.
• Checking of appeals, duplicates, and underpaid claims too.
• Checking medical records as per system entry.
• Sending claims to the clinical investigation team for review of records.
• Finally, my core work is to pay insurance claims.