The AR Analyst is responsible for the timely follow-up and resolution of insurance claims to ensure accurate and efficient reimbursement for healthcare providers. This role involves analyzing A/R data, performing claim status checks, handling denials, and maintaining compliance with U.S. healthcare billing and regulatory requirements. The A/R Analyst plays a critical role in optimizing cash flow, reducing days in A/R, and supporting overall revenue cycle performance.

Essential Functions: In addition to working as prescribed in our Performance Factors specific responsibilities of this role include:

• Perform pre-call analysis and check claim status via payer calls, IVR, or payer web portals.
• Document all claim activities in client software, ensuring a clear and compliant audit trail.
• Conduct post-call analysis and record after-call actions for claims follow-up.
• Review and interpret Explanation of Benefits (EOBs), authorizations, medical documentation, and physician notes prior to contacting payers.
• Analyze A/R data to identify underpayments, denials, and root causes; document with appropriate denial/adjustment codes.
• Ensure compliance with all reimbursement, billing, and regulatory requirements (including HIPAA).
• Convert denials into payments by filing appeals or correcting claim errors.
• Perform eligibility checks, claim submission, and resubmission as required.
• Monitor fresh claims, denials, suspensions, and appeals to ensure timely resolution.
• Meet or exceed daily/weekly productivity and quality targets.

All activities must be in compliance with Equal Employment Opportunity laws, HIPAA, ERISA, and other applicable regulations.

Key Result Areas (KRAs)

Category

Target

Weightage

Remarks

Production

≥ 100%

40%

Regular claims and denials

Quality

≥ 98.5%

40%

Achieve your set target on a monthly basis

Follow SOPs and Checklists

≥ 95%

10%

Follow SOPs, Site Books, and Checklists

Time on System

9 hrs daily

4%

Meet required 9 hrs time-on-system mandate (only 3 days non-adherence allowed)

Shift Adherence

Login before shift time

3%

Meet required shift start/end mandate (only 2 days non-adherence allowed)

Unapproved Leaves

0

3%

No unapproved leaves allowed

All activities must be in compliance with Equal Employment Opportunity laws, HIPAA, ERISA and other regulations, as appropriate. 

Minimum Requirements:

• High School (HSC) or Graduate equivalent.
• 2+ years of experience in U.S. healthcare accounts receivable follow-up and/or denial management.
• Strong written and verbal communication skills.
• Working knowledge of medical terminology, ICD-10, CPT, and HCPCS codes.
• Basic computer proficiency.
• Willingness to work continuous night shifts.

Education / Experience / Certification:

• Prior experience in U.S. healthcare BPO/RCM preferred.
• Experience with acute EHR systems (hospital-based electronic health record platforms).
• Familiarity with clearinghouses such as Waystar, Realmed, Availity, Change Healthcare, and ViaTrack.
• Proficiency in MS Excel, MS Word, and Google Sheets preferred.

Skills & Technical Proficiency:

• Strong analytical and problem-solving skills with attention to detail.
• Assertive and effective in resolving unpaid claims.
• Ability to manage multiple tasks while processing high volumes of claims accurately.
• Strong organizational and time management skills.
• Ability to work independently with minimal supervision.
• Commitment to maintaining confidentiality and compliance with HIPAA.

Working Environment/Physical Demands

Working Environment:

• General office environment: Works generally at a desk in a well-lighted, air-conditioned office, with moderate noise levels. 
• Periods of stress may occur.

Physical Demands:

• Activities require a significant amount of sitting at office and work desks and in front of a computer monitor.
• Some walking and standing relative to interaction with other personnel. 

Travel Requirements:

    None       Occasional             Moderate          Frequent           Very Frequent

                            (25% or Less)                  (25% - 40%)               (40% - 80%)             (80% or m

Other possible Unofficial Titles

Unofficial titles may be given by the manager and used for email signature.