Key Responsibilities:
Denial Management & Appeal: Analyze complex and high-dollar denied claims, identify denial trends, and draft medical appeals to insurance carriers.
Process Leadership: Act as the ultimate process owner, providing guidance on payment posting, charge entry, and insurance AR follow-up.
Training & Quality Assurance (QA): Conduct process training and knowledge-sharing sessions for current hires and junior AR associates. Monitor quality to meet client SLAs (Service Level Agreements).
Compliance: Ensure all billing practices strictly adhere to healthcare regulations, payer guidelines, and HIPAA standards.
SOP Maintenance: Develop and maintain Standard Operating Procedures (SOPs), process documentation, and training manuals.

Qualifications & Requirements
Experience:



Typically 4 to 8+ years of experience in US Healthcare Revenue Cycle Management (RCM), specifically focusing on physician or hospital billing and AR.
Domain Knowledge: Deep understanding of CMS guidelines, Medicare/Medicaid policies, and commercial insurance claim lifecycles.
Technical Proficiency: Hands-on experience with medical billing software (e.g., Epic, NextGen, Kareo) and clearinghouse portals.
Soft Skills: Solid analytical capabilities, excellent communication skills for client interactions, and a proven track record of mentoring teams.

📌 Medical Billing Subject Matter Expert Hyderabad
🏢 Credense Medical Billing
📍 Hyderabad