Role Description Review and analyze insurance denials and rejections.

Identify the root cause of denials and take appropriate corrective action.

Work on denial prevention and denial management initiatives.

Validate and correct coding, documentation, and billing errors causing claim denials.

Research payer policies, eligibility, coverage, and authorization requirements.

Prepare and submit appeals with supporting documentation.

Track and follow up on denied claims until resolution.

Maintain denial logs, reports, and trend analysis.

Collaborate with Coding, Billing, and Accounts Receivable teams to reduce denials.

Monitor denial KPIs and contribute to continuous process improvement.

Qualifications Required Certifications

CPC, CPC-A, COC, CCS , CCS-P, RHIA, RHIT, CCA





Solid knowledge of Medical Coding (ICD-10-CM, CPT, HCPCS, Modifiers).

Understanding of payer guidelines and denial reasons (835/ERA).

Ability to interpret EOBs, denial letters, and payer communications.

Strong analytical and problem-solving skills.

Experience in denial management and root cause analysis.

Proficiency in Microsoft Excel (Pivot Tables, VLOOKUP, Reports).

Excellent documentation and communication skills.

Knowledge of reimbursement rules and regulations.

Familiarity with billing and claims management systems

📌 Certified Denials coders (Hyderabad)
🏢 Smartclues Technologies
📍 Hyderabad