Appeals Analyst - RCM Process

Job Title: Appeals Analyst – Revenue Cycle Management (RCM)

Department: Revenue Cycle / Medical Billing
Location: Onsite – Gachibowli, Hyderabad
Employment Type: Full-time

Job Summary

The Appeals Analyst is responsible for managing and resolving denied or underpaid medical claims by preparing, submitting, and tracking claim appeals to insurance payers. The role ensures timely and accurate appeal submissions to optimize revenue recovery and reduce accounts receivable days within the RCM process.

Key Responsibilities

• Denial Review: Analyze Explanation of Benefits (EOBs), remittance advices, and payer denial codes to identify the root cause of denials.
• Appeal Preparation: Draft and submit appeal letters with appropriate documentation, medical records, and payer-specific forms within timely filing limits.
• Follow-Up: Monitor and track appeal status through payer portals, calls, or emails until resolution is received.
• Compliance: Ensure all appeals are handled in accordance with payer policies, HIPAA regulations, and internal quality standards.
• Documentation: Maintain accurate notes and status updates in the billing/RCM system
• Reporting: Generate and share regular reports on appeal outcomes, recovery rates, and denial trends with management.
• Continuous Improvement: Assist in process improvement initiatives to enhance denial management efficiency and reduce future denials.

Required Skills and Qualifications

• Bachelor’s degree (preferred) or equivalent work experience in healthcare, finance, or business administration.
• 1–3 years of experience in RCM, medical billing, denials management, or appeals.
• Strong knowledge of payer guidelines, claim adjudication processes, and medical billing terminologies (CPT, ICD-10, HCPCS).
• Excellent analytical, written, and verbal communication skills.
• Proficiency in RCM software, payer portals, and Microsoft Office (Excel, Word, Outlook).
• Ability to manage multiple cases and meet deadlines in a fast-paced environment.

Preferred Qualifications

• Experience with high-volume hospital or physician billing appeals.
• Knowledge of CMS, Medicare, and commercial payer policies.

Job Type: Full-time

Work Location: In person