Role Description - Perform pre-call analysis and check the status by calling the payer or using IVR or web portal services. - Maintain adequate documentation on the client software to send the necessary documentation to insurance companies and maintain a clear audit trail for future reference. - Record after-call actions and perform post-call analysis for the claim follow-up. - Provide accurate information to the insurance company, research available documentation including authorization, physician notes, medical documentation on PM system, interpret explanation of benefits received, etc. prior to making the call. - Perform analysis of accounts receivable data and understand the reasons for underpayment, days in A/R, top denial reasons, use appropriate codes to be used in documentation of the reasons for denials/underpayments. - Comply with all reimbursement and billing procedures for regulatory, third party, and insurance compliance norms. - Responsible for meeting daily/weekly productivity and quality reasonable work expectations. Responsibilities - Claim processing and submission. - Submit the claim to insurance companies to receive payment for services rendered by a healthcare provider. - Taking denial status from various insurance carriers. - Checking eligibility and verification of policy. - Analysis of the data. - Converting denials into payments. - Follow Health Insurance Portability and Accountability Act (HIPAA). - Account follow up on fresh claims, denials, and appeals. - Checking the claim status as per their suspension and denials. - Achieving weekly/monthly production and audit target. Qualifications - High School (HSC) or graduate or equivalent with strong analytical skills. - 1-3 Years of experience in accounts receivable follow-up/denial management for US healthcare. - Good written and verbal communication skills. - Knowledge of medical terminology, ICD10, CPT, and HCPC coding. - Basic working knowledge of computers. - Willingness to work continuously in night shifts. Preferred - Familiar with healthcare patient billing systems (Practice management) like NextGen, eCW, Carecloud, Docutap. - Familiar with clearinghouse like Waystar, Realmed Availity, change healthcare, via track. - Proficiency with MS Excel, MS Word, google spreadsheet, etc. Other Skills and Abilities - Ability to work independently with minimal supervision. - Good analytical skills, assertive in resolving unpaid claims. - Ability to multi-task and accurately process high volumes of work. - Strong organizational and time management skills. Company Description Individual Contributor

Role Description The AR/Payment Posting Specialist is responsible for managing all aspects of the claims lifecycle, from claim submission to resolution, including appeals, follow-ups with payers, and denial management. This role is essential in ensuring accurate and timely reimbursement for services rendered by our providers, including support to Payment Poster. Responsibilities - Identify, investigate, and resolve unpaid claims utilizing Payor portals to follow up on submitted claims. - Call insurance companies when claims are denied and work with commercial/government payers. - Research denials and rejections as well as payor policies. - Submit claims’ reconsiderations and appeals, documenting account activity. - Manage medical records requests. - Track and trend payor issues. - Collaborate with Billing, Cash Posting, Contracting, and Intake on issues affecting account resolution. - Apply manual payments and auto payments to accounts for payor types of Medicare, Medicaid, and Commercial Insurances. - Analyze EOB information, including co-pays, deductible, co-insurance, contractual adjustments, denials, and more to verify accuracy of patient balances. - Other duties as assigned. Qualifications - Knowledge of CPT, HCPCS, ICD-10 coding, and payer rules related to behavioral health services. - Knowledge of insurance plans, policies, and procedures. - Proficiency in using EHR systems and insurance verification software. - Understanding of payment reconciliation and basic accounting practices. - Proficiency in Zoom/Google Meets and other virtual meeting platforms. - Strong organizational and multitasking skills. - Excellent verbal and written communication skills. - Detail-oriented with a high level of accuracy. - Ability to handle sensitive member and payment data in compliance with regulatory standards. - Ability to use discretion and work independently under general supervision. - Ability to work as part of a team. - Ability to understand and adhere to the Professional Code of Conduct. Requirements - High school diploma or equivalent; associate's degree or relevant certification preferred. CPC highly advantageous. - Minimum of 2+ years of experience in following up/resolving outstanding medical claims. - Access to reliable internet and telephone services, specifically 40M download and 10M upload package or higher as well as a strong WiFi signal from your remote work location. - Must meet pre-employment requirements and maintain all applicable state and job-related guidelines for background screening. Physical Requirements & Working Conditions These physical demands are representative of the physical requirements necessary for an employee to successfully perform the essential functions of the job. Reasonable accommodation can be made to enable people with disabilities; these are made on a case-by-case basis. - While performing the responsibilities of the role, the employee is required to talk and hear. - The employee is often required to sit and use his or her hands and fingers. - The employee is occasionally required to stand, walk, and reach with arms and hands. - Vision abilities required by this job include close vision. Limitations and Disclaimer The above job description is meant to describe the general nature and level of work being performed; it is not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required for the position. Other duties may be assigned from time to time. Equal Employment Opportunity Statement Groups is an equal opportunity employer committed to diversity and inclusion in all aspects of recruiting and employment. All qualified individuals are encouraged to apply and will receive consideration without regard to race, color, gender, gender identity or expression, sex, sexual orientation, transgender status, gender dysphoria, national origin, age, religion, disability, military and veteran status, marital or parental status, citizenship status, genetic information, or any other factor which cannot lawfully be used as a basis for an employment decision.

• Manage outstanding balances and foster positive customer relationships • Resolve payment issues and focus on aged accounts • Collaborate with stakeholders to document interactions

• Follow-up with insurance payers on outstanding claims • Break down obstacles to payment and accelerate cash collections • Utilize experience and follow-up strategies and tools to resolve claims • Document client’s host system using the 5 W’s framework • Write first and second level appeals of all denials • Escalate unpaid claims to payer claims supervisor as appropriate • Research and analyze any correspondence related to assigned accounts