AR Executives Denial Specialists | US Healthcare RCM | Multiple Openings

Denial Management & Appeals: Radiology, Cardiology, Ophthalmology, Pulmonary, Neurology, Vascular & Procedures

Company: NPB Consultants Pvt. Ltd. (NPB Health)
Location: New Delhi office / Hybrid / Remote
Experience: 2-7 years in US Healthcare AR / denial management
Shift: 6:30 PM 3:30 AM IST (US Eastern business hours)
Openings: 10
Notice Period: Immediate to 30 days preferred

About Us
NPB Consultants Pvt. Ltd. (NPB Health) is a trusted partner in US Healthcare Revenue Cycle Management. We support a large multi-specialty medical group in New York with 130+ providers across 20+ locations, working directly on their claims across a wide range of specialties. Were expanding our RCM team and hiring denial management professionals at multiple levels as our work grows. Join a team that values skill, integrity, and excellence.

Role Overview
We’re looking for hands-on Denial Specialists who resolve denied claims every day. You’ll read the denial, find the real reason behind it, fix what needs fixing, and get the claim paid through correction, resubmission, reconsideration, or appeal. You’ll work on specialty claims across Radiology, Cardiology, Ophthalmology, Pulmonary, Neurology, Vascular, and procedure-based services, primarily with New York payers.

You’ll also help stop denials from coming back by spotting patterns and flagging them so the root cause can be fixed upstream.

This is a production role for people who enjoy solving denials, not a reporting or analyst role.

Positions Available

- Denial Specialist (2–4 years): Work assigned denied claims, including root-cause review, correction, resubmission, and standard appeals.
- Senior Denial Specialist (4–7 years): Handle complex and high-value denials, multi-level appeals, and aged denied AR, and support newer team members.

Candidates will be placed at the right level based on experience and assessment.

Key Responsibilities

- Work assigned denied claims end to end: review the EOB/ERA, interpret CARC/RARC codes,



identify the true root cause, and take the action needed to get the claim paid.
- Categorize each denial accurately (e.g., eligibility/coverage, prior authorization, medical necessity, coding/modifier, bundling, timely filing, COB, duplicate, missing information, provider enrollment/credentialing) so trends can be tracked correctly.
- Decide the right resolution path for each denial: corrected claim, resubmission, reconsideration, or formal appeal.
- Write clear, well-supported appeals and reconsideration requests, attaching the right documentation (medical records, authorization proof, payer policy references, proof of timely filing).
- Handle specialty-specific denials, including prior authorization denials for imaging and procedures, medical necessity denials, modifier issues, global period and bundling (NCCI) edits, and professional vs. technical component billing.
- Track appeal deadlines and timely filing limits by payer, and prioritize denials by deadline, value, and age to prevent avoidable write-offs.
- Follow up on submitted appeals and reconsiderations through payer calls, portals, and clearinghouse tools until a final decision is received; escalate to the next appeal level when warranted.
- Work aged denied AR (60+, 90+, and 120+ days), including older backlog denials, and recover payment before claims become uncollectable.
- Work denials for New York plans, including NYS Government Employees (Empire Plan), Fidelis Care, EmblemHealth, BCBS, Medicare, Medicaid, and commercial payers.
- Identify recurring denial patterns by payer, code, specialty, or provider and report them to the Team Lead with examples, so front-end, coding, or billing fixes can be made.




- Flag claims that may indicate an overpayment or coding concern to the Team Lead instead of appealing them.
- Document every action, appeal, and outcome clearly and accurately in the practice management system.
- Meet daily productivity and quality targets.
- Follow HIPAA requirements and handle patient information securely at all times.

Required Skills

- 2+ years of hands-on US Healthcare denial management experience (not only AR calling).
- Hands-on experience resolving denials in at least two of these specialties: Radiology, Cardiology, Ophthalmology, Pulmonary, Neurology, Vascular, or procedure-based services.
- Strong working knowledge of CARC/RARC denial codes and the correct resolution for each.
- Proven experience writing and submitting appeals and reconsiderations, including multi-level appeals.
- Working knowledge of CPT, ICD-10, and common modifiers (e.g., 25, 26, TC, 59/XS, 24, 79, RT/LT).
- Understanding of prior authorization, medical necessity, global periods, bundling (NCCI edits), timely filing, appeal limits, and COB.
- Ability to read and apply payer medical policies and LCD/NCD guidelines when building an appeal.
- Experience with payer portals (e.g., Availity, payer-specific portals) and payer calling.
- Experience with at least one PM/EMR system.
- Positive spoken and written English for payer calls, appeal letters, and claim documentation.
- Accuracy, attention to detail, analytical thinking, and ownership of assigned claims.

Nice to Have

- Experience with New York plans: Empire Plan, Fidelis Care, EmblemHealth, BCBS, NY Medicaid.
- Experience with eClinicalWorks (robust plus).
- Experience with radiology benefit managers and authorization vendors (e.g., eviCore, Carelon).
- Experience with denial tracking, trending, or root-cause categorization.
- Multi-specialty group experience.
- Coding certification (CPC, CCS-P, or similar).

Why Join NPB Health
Career growth opportunities, a supportive work culture, performance recognition, and competitive benefits.

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