HB AR callers / Hospital Billing AR/ Mumbai/ Ub04 / HB / AR Calling

ECLAT Health Solutions; Mumbai, Navi Mumbai; On-site; INR 300,000 - 540,000; Full time

Job summary

Eclat Health Solutions in Mumbai is seeking an AR Caller - Hospital Billing (UB-04) with 1–6 years of experience. You will follow up on unpaid claims, analyze denials and underpayments, and drive resolutions with insurance providers to improve cash flow.

The role covers government and commercial payers, handling claim status inquiries, appeals, and denials, while ensuring accurate documentation in billing systems.

Qualifications

• 1–6 years of experience in Hospital Billing / AR / RCM.
• Proficient in UB-04 claim forms and billing terminology.
• Knowledge of TOB and Revenue Codes.
• Understanding DRG reimbursement and downgrades.
• Familiar with POA indicators and 72-hour rule.
• Experience with ED CPT codes and radiology billing.
• Ability to research denials and communicate with payers.

Responsibilities

• Follow up on unpaid and denied claims with insurers.
• Analyze denials, underpayments, and variances.
• Review paid claim information for reimbursement discrepancies.
• Work with Government and Commercial payers (Medicare, Medicaid, BCBS, Aetna, Cigna, UHC, Humana, etc.).
• Handle claim status inquiries, appeals, reconsiderations, and escalations.
• Resolve billing issues to maximize collections and reduce AR days.
• Verify eligibility, benefits, coverage limitations, waiting periods, cooling periods, and authorization requirements.
• Research and resolve denials related to coding, billing, and payer policies.
• Document account actions accurately in billing systems.

Skills

Hospital Billing

UB-04 Forms

TOB

Revenue Codes

DRG

DRG Downgrades

POA indicators

72-Hour Rule

ED CPT Codes

Professional vs Technical Components

Radiology Billing

Job description

Job Opening - AR Caller (Hospital Billing) | 1 to 6 Years Experience

Location: Mumbai
Company: Eclat Health Solutions
HR Contact: HR Phani - 9494994261

Location : Office Address-

Eclat Health Solutions (I) Pvt Ltd

7TH floor of tower 1, Mindspace Juinagar, Plot no Gen 2/1/F,

TTC Industrial Area, Shiravane, Juinagar,

Navi Mumbai, Maharashtra 400705

Position: AR Caller - Hospital Billing (UB-04)

Experience Required:

1 - 6 Years in Hospital Billing / Accounts Receivable (AR) / Revenue Cycle Management (RCM)

Roles & Responsibilities

• Follow up on unpaid and denied hospital claims with insurance companies.
• Analyze claim denials, underpayments, and payment variances.
• Review paid claim information and identify reimbursement discrepancies.
• Work on Government and Commercial payers including Medicare, Medicaid, Managed Care, BCBS, Aetna, Cigna, UHC, Humana, etc.
• Handle claim status inquiries, appeals, reconsiderations, and escalations.
• Resolve billing-related issues to maximize collections and reduce AR days.
• Verify eligibility, benefits, coverage limitations, waiting periods, cooling periods, and authorization requirements.
• Research and resolve claim denials related to coding, billing, and payer policies.
• Document account actions accurately in billing systems.

Required Knowledge & Skills

Hospital Billing

• Strong working knowledge of UB-04 Claim Forms.
• Understanding of Type of Bill (TOB) and Revenue Codes.
• Knowledge of DRG (Diagnosis Related Group) reimbursement methodology.
• Experience handling DRG Downgrades and DRG payment disputes.
• Understanding of POA (Present on Admission) indicators.
• Knowledge of 72-Hour Rule and claim bundling regulations.
• Familiarity with Emergency Department CPT Codes.
• Understanding of Professional vs Technical Components.
• Knowledge of Radiology Billing and Coding.

Insurance Concepts

• Medicaid Spend Down knowledge.
• Coordination of Benefits (COB).
• Birthday Rule determination.
• Waiting Period and Cooling Period analysis.
• Coverage verification and benefit investigation.

Payment & Denials

• Experience identifying and resolving:
• Underpayments
• Claim denials
• Claim edits
• Authorization denials
• Medical necessity denials
• Coding denials
• Eligibility denials

Adjustment & Remark Codes

Knowledge of denial and adjustment codes including:

• CO-18 Duplicate Claim/Service
• CO-22 Coordination of Benefits
• CO-50 Medical Necessity Not Met
• CO-197 Precertification/Authorization Required

Coding Knowledge

• Basic ICD-10, CPT and HCPCS understanding.
• Revenue Code validation.
• Modifier usage and reimbursement impact.

Modifier Knowledge

Experience with:

• Modifier 24 – Unrelated E&M During Postoperative Period
• Modifier 25 – Significant Separately Identifiable E&M Service
• Modifier 50 – Bilateral Procedure