We are looking for an analytical and detail-oriented Denial Management Executive with experience in US Healthcare Revenue Cycle Management. The candidate will be responsible for identifying claim denials, analysing denial reasons, correcting billing issues, preparing appeals, and following up with insurance companies to ensure maximum reimbursement for healthcare providers.
Key Responsibilities:
- Review and analyse denied medical claims.
- Identify denial reasons using CARC and RARC codes.
- Investigate claim rejections and payment discrepancies.
- Verify insurance eligibility and authorization requirements.
- Identify coding, billing, documentation, and claim submission errors.
- Prepare and submit corrected claims and appeals.
- Follow up with insurance companies regarding outstanding and denied claims.
- Work on timely resolution of denials to reduce revenue loss.
- Coordinate with Charge Entry, Coding, Payment Posting, and AR teams.
- Maintain denial tracking reports and identify recurring denial trends.
- Meet daily productivity, quality, and resolution targets.
Required Skills:
- Strong knowledge of US Healthcare RCM and medical billing.
- Understanding of insurance denials and claim processing.
- Knowledge of CPT, ICD-10, and HCPCS codes.
- Understanding of CARC and RARC codes.
- Knowledge of claim appeals and corrected claim procedures.
- Understanding of insurance eligibility and prior authorization.
- Good communication, analytical, and problem-solving skills.
- Experience with medical billing software and MS Excel.
Pay: ₹18,000.00 - ₹30,000.00 per month
Advantages:
- Food provided
- Health insurance
- Provident Fund