UR - Utilization Review Specialist

Avc Informatics; Bengaluru; On-site; INR 350,000 - 550,000; Full time

Benefits offered by this job

As per market standards

Job summary

Avc Informatics is seeking a detail-oriented Medical Billing AR Specialist to join our Bengaluru operations. The role focuses on utilization review, data integrity, and efficient authorization workflows to ensure timely patient care and accurate reimbursements.

Responsibilities include reviewing clinical docs, coordinating with clinicians, and managing payer communications while adhering to regulatory requirements and market standards.

Qualifications

• Needs a Bachelor’s degree or 3-year diploma equivalent.
• Minimum 2 years of medical billing AR calling/analysis experience required; UR experience preferred.
• Willing to work night shifts aligned to US time zones.

Responsibilities

• Conduct utilization review and ensure adherence to payer guidelines and regulatory requirements.
• Review clinical documentation, treatment plans, and patient records.
• Collaborate with therapists and physicians to obtain required information and ensure continuity of care.
• Review and manage UR activities and authorizations; use payer portals as needed.
• Verify insurance eligibility and benefits for patients; follow up on denied claims.
• Identify and bill secondary/tertiary insurances and research denied claims.

Skills

Interpersonal skills

Computer skills

Problem analysis

Communication

Organization

Multi-tasking

Program management

Relationship building

Diverse backgrounds

MS Office

Education

Bachelor's degree or 3-year diploma

Tools

Practice management software

Job description

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Conduct comprehensive utilization review activities for behavioral health services, ensure adherence to payer guidelines, medical necessity criteria, and regulatory requirements.
• Review and analyze clinical documentation, treatment plans, and patient records
• Collaborate with therapists, physicians and other clinical staff to obtain required information and ensure seamless continuity of care.
• Good understanding with EMR systems ifor documentation review, tracking, and utilization management.
• Manage prior authorizations through payer portals.
• Verify referrals/authorizations for denied procedures. Obtain and work with the practice to correct any referrals/authorizations for denied procedures.
• Checking insurance eligibility and benefits for patients, as needed.
• Reviewing patient accounts for accuracy and completeness and obtaining any missing information.
• Ensure accurate submissions, benefit verification, timely follow-ups, and successful approvals.
• Following up on unpaid claims within standard billing cycle timeframe for the client and carrier.
• Checking each insurance payment for accuracy and compliance with contract discount, as necessary.
• Calling insurance companies regarding any discrepancy in payments if necessary
• Identifying and billing secondary or tertiary insurances.
• Reviewing accounts for insurance of patient follow-up including review and research of self-pay, refund accounts for insurance.
• Researching and appealing denied claims. Coding research appeals and corrections at the discretion of the client and management.
• Answering patient or insurance telephone inquiries pertaining to assigned accounts.
• Understand CPT codes and ICD-10 codes and when these can be changed or not.
• Understand the insurance carriers requirements for submitting claims and appeals.
• Understand special situations and procedures that relate to the specialty you work on.
• Performs other duties as assigned.

MINIMUM JOB REQUIREMENTS

• Bachelors Degree or a 3 year Diploma or equivalent is required.
• Two (2) years of medical billing AR Calling/Analysis experience is required. Two (2) years of UR experience is preferred
• Willing to work night shifts as per US time zones

Education, Training, and Experience Required:

• Excellent interpersonal skills.
• Solid computer/technology skills.
• Excellent ability to analyze problems and select proper resolution.
• Excellent written and oral communication skills.
• Excellent ability to organize tasks and work independently.
• Ability to multi-task.
• Effectively implement and manage assigned programs and functions.
• Establish and maintain effective working relationships with individuals at all levels of the organization.
• Ability to communicate effectively and clearly with people from diverse backgrounds.
• Ability to competently use Microsoft Office, including Word, Outlook, Excel, and appropriate practice management software.
  

Knowledge/Skills/Abilities:

• Excellent interpersonal skills.
• Solid computer/technology skills.
• Excellent ability to analyze problems and select proper resolution.
• Excellent written and oral communication skills.
• Excellent ability to organize tasks and work independently.
• Ability to multi-task.
• Effectively implement and manage assigned programs and functions.
• Establish and maintain effective working relationships with individuals at all levels of the organization.
• Ability to communicate effectively and clearly with people from diverse backgrounds.
• Ability to competently use Microsoft Office, including Word, Outlook, Excel, and appropriate practice management software.
  

Perks and Benefits

As per market standards