Job Summary

We are looking for an experienced Senior Denial Management Specialist with 3–4 years of experience in U.S.

Healthcare Revenue Cycle

Management (RCM), specifically in DME and IDTF denial management. The candidate will be responsible for reviewing, analyzing, resolving, and appealing denied claims, following up with insurance payers, identifying root causes of denials, and ensuring timely claim resolution and reimbursement. Strong hands-on experience with Brightree billing software and knowledge of U.S. healthcare payer processes are required.

Key Responsibilities

· Manage and resolve DME and IDTF claim denials from various U.S. insurance payers.

· Review denial codes, EOBs/ERAs, payer responses, and claim documentation to identify denial reasons.

· Perform denial analysis and identify root causes.

· Take corrective action, including claim correction, resubmission, reconsideration, or appeal.

· Prepare and submit appeals and reconsiderations within payer-specific timelines.

· Follow up with insurance companies through payer portals, phone calls, and other approved channels.

· Work on AR follow-up related to denied and underpaid claims.

· Identify recurring denial trends and communicate issues to relevant billing/intake teams.

· Review patient, insurance, authorization, documentation, coding, and billing information contributing to denials.

· Ensure claims are worked within timely filing and appeal deadlines.

· Maintain accurate documentation of denial actions, follow-ups, appeal status, and resolutions.

· Use Brightree to review claims, billing information, denial details, account history, and supporting documentation.





· Monitor assigned denial inventory and ensure pending accounts are followed up regularly.

· Coordinate with billing, coding, eligibility, authorization, and operations teams to resolve claim issues.

· Maintain productivity and quality targets established by the organization.

· Prepare regular updates/reports on denial status, aging, recovery, and outstanding accounts.

Required Skills & Qualifications

· 3–4 years of experience in U.S. Healthcare RCM / Denial Management.

· Strong hands-on experience in DME and IDTF denial management.

· Mandatory: Hands-on experience with Brightree billing software.

· Knowledge of U.S. healthcare insurance and payer processes.

· Strong understanding of claims, denials, appeals, resubmissions, and AR follow-up.

· Ability to understand and interpret EOBs/ERAs and denial reason codes.

· Positive written and verbal English communication skills.

· Good typing speed and computer proficiency.

· Ability to work independently and manage multiple accounts/denials.

· Strong attention to detail and documentation skills.

· Willingness to work 6:30 PM – 3:30 AM IST in the CST time-zone shift.

Preferred Qualifications

· Experience working with Medicare, Medicaid, Medicare Advantage, and commercial payers.

· Experience handling DME/IDTF claims from denial through resolution.

· Knowledge of authorization, medical necessity documentation, eligibility, and payer requirements.

· Experience with denial tracking and productivity/AR reports.

Pay: ₹35,000.00 - ₹48,000.00 per month

Benefits

- Leave encashment
- Provident Fund

Work Location: In person

📌 Senior Denial Management Specialist – DME/IDTF (Ahmedabad)
🏢 IRVx Softlabs
📍 Ahmedabad