AR Appeal Associate

Job Title: Accounts Receivable (AR) Denial & Appeals Analyst
Department: Revenue Cycle Management (RCM) / Patient Financial Services
Reports To: AR Manager / Revenue Cycle Manager
FLSA Status: Exempt / Non-Exempt

Position Purpose

The AR Denial & Appeals Analyst is responsible for identifying, investigating, and resolving denied or underpaid complex medical insurance claims. This role requires deep knowledge of healthcare billing, Claim Adjustment Reason Codes (CARCs), and medical policies to formulate compelling, fact-based clinical and technical appeal letters. The primary objective is to overturn insurance denials, maximize revenue recovery, and decrease outstanding Days Sales Outstanding (DSO).

Key Responsibilities

Denial Analysis & Investigation

• Evaluate incoming insurance denials by decoding HIPAA-standard CARC and RARC indicators (e.g., medical necessity, bundled codes, or timely filing limits). [1]
• Audit medical documentation, patient eligibility records, and provider contract rates to locate the root cause of short-pays or rejection trends.
• Differentiate between technical denials (missing details, registration errors) and clinical denials (medical necessity, experimental treatments) to assign the correct resolution path.

Appeal Generation & Submission

• Draft and submit highly persuasive first-, second-, and third-level appeal letters tailored to specific commercial, Medicare, Medicaid, and managed care payer policies.
• Collaborate closely with physicians, clinical staff, and the coding team to gather necessary documentation, including operative reports, progress notes, and letters of medical necessity.
• Ensure all appeal packages contain proof of timely filing, authorization logs, and clinical trial evidence matching state and federal healthcare regulations.

Payer Follow-Up & Dispute Resolution

• Contact commercial and government insurance representatives regularly to track the status of submitted appeals and negotiate settlements.
• Coordinate directly with clearinghouse partners and EDI support staff to address claims dropped during transmission or stuck in processing loops.
• Execute telephone or portal-based appeals to rapidly correct pricing errors, faulty write-offs, or claims forwarded to incorrect internal payer lines.

Tracking, Reporting, & Process Improvement

• Track active appeal success rates and compile monthly reports detailing financial recovery metrics and emerging denial trends for leadership.
• Identify systemic issues in billing or frontend registration and recommend preventative workflow fixes to minimize future denial rates.

Core Competencies & Skills

• Coding Proficiency: Familiarity with ICD-10-CM/PCS, CPT, HCPCS Level II, and NCCI edit guidelines.
• Payer Rules: In-depth knowledge of ERISA rules, Medicare National Coverage Determinations (NCDs), and Local Coverage Determinations (LCDs).
• Communication: Ability to write clinical arguments with objective, data-backed technical vocabulary.
• Technical Aptitude: Experience navigating Electronic Health Records (EHR) and clearinghouse portals.

Job Requirements & Qualifications

Education & Experience

• Degree: Associate’s or Bachelor’s degree in Healthcare Management, Finance, Nursing, Health Information Management (HIM), or a related field (strongly preferred).
• Experience: Minimum of 3–5 years of dedicated experience in healthcare revenue cycle operations, medical billing, or insurance denial management.
• Certifications: Highly desirable credentials include Certified Professional Coder (CPC), Certified Risk Adjustment Coder (CRC), or Certified Revenue Cycle Representative (CRCR).

Software Systems (Preferred)

• EHR platforms: Epic, Cerner, eClinicalWorks, or NextGen.
• Accounting/Data tools: Advanced proficiency in Microsoft Excel (VLOOKUPs, pivot tables)

Pay: ₹11,021.09 - ₹34,802.52 per month

Work Location: In person