The AR Senior Analyst is responsible for leading advanced A/R follow-up, analysis, and resolution activities to ensure accurate and timely reimbursement for healthcare providers. This role requires deep knowledge of payer policies, denial management, and U.S. healthcare billing regulations. The AR Senior Analyst will handle high-value, aged, and complex claims while providing analytical insights and process improvement recommendations to optimize overall cash flow and reduce days in A/R.

In addition to performing detailed claim analysis, the Senior Analyst may mentor junior analysts, support team training, and assist with escalations that impact key revenue cycle performance indicators.

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

• Conduct in-depth pre-call analysis to determine root causes of unpaid or underpaid claims.
• Contact payers through calls, IVRs, or web portals for claim status, resolution, and escalation when necessary.
• Handle complex denials and aged accounts by identifying trends and recommending corrective actions.
• Document all claim-related activities comprehensively in client software for a compliant and auditable trail.
• Interpret and analyze Explanation of Benefits (EOBs), medical documentation, authorizations, and payer correspondence.
• Prepare and submit appeals for denied or underpaid claims; ensure adherence to payer-specific timelines.
• Monitor and track high-dollar, aged, and specialty claims through to resolution.
• Collaborate with team members to improve workflow efficiency and data accuracy.
• Support audit requests and ensure strict compliance with HIPAA, ERISA, and payer-specific requirements.
• Mentor junior analysts by sharing best practices and supporting performance improvement.

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

Key Result Areas (KRAs)

Category

Target

Weightage

Remarks

Production

• 100%

40.0%

High $ value claims, Aged & Complex claims

Quality

• 98.5%

40.0%

Achieve your set target on a monthly basis

Follow SOPs and Checklists

100%

8.0%

Follow SOPs, Site Books, and Checklists

Time on System

9 hrs daily

4.0%

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

Shift Adherence

Login before shift time

3.0%

Meet required shift start/end mandate (only 2 days non-adherence allowed per month for full marks)

Initiatives

n

5.0%

• Offers help to Supervisor• Seeks learning through added responsibilities• Takes initiative to understand processes better

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

Minimum Requirements:

• Graduate (Bachelor’s degree or equivalent).
• Minimum 3–5 years of experience in U.S. healthcare accounts receivable follow-up and denial management, with demonstrated expertise in handling complex and high-value claims.
• Strong communication and analytical skills with the ability to present insights to leadership.
• Solid understanding of U.S. healthcare reimbursement, payer rules, and regulatory requirements.
• Working knowledge of ICD-10, CPT, and HCPCS codes.
• Proficiency in Microsoft Office (Excel, Word, PowerPoint) and EHR platforms.
• Willingness to work continuous night shifts and flexible schedules when required.

Education / Experience / Certification:

• Bachelor’s degree preferred (Healthcare, Finance, or related field).
• Prior experience in U.S. healthcare BPO/RCM strongly preferred.
• Exposure to acute EHR systems (hospital-based) and clearinghouses such as Waystar, Realmed, Availity, Change Healthcare, and ViaTrack.
• Certification in Medical Billing/Coding (optional but preferred).

Skills & Technical Proficiency:

• Advanced analytical and problem-solving abilities with a focus on data-driven decision-making.
• Expertise in denial management, payer follow-ups, and revenue recovery strategies.
• Strong attention to detail with the ability to process high volumes of claims accurately.
• Effective time management and organizational skills.
• Ability to work independently with minimal supervision while supporting team goals.
• Excellent interpersonal skills for cross-functional collaboration.
• Commitment to confidentiality and strict compliance with HIPAA and internal quality standards.

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.

Individual Contributor