Denial Management specialist

A Denials ere's Job

Position Summary:

The Denials Management Specialist is responsible for reviewing and resolving denied or rejected insurance claims to maximize reimbursement. This role involves analyzing denial trends, identifying root causes, and working with payers, internal departments, and appeals teams to prevent future denials and improve collection rates.

Key Responsibilities:

• Review and analyze insurance claim denials and rejections.
• Determine the root cause of denials and take corrective action.
• Prepare and submit appeals with supporting documentation as needed.
• Communicate with insurance companies to follow up on pending or denied claims.
• Work collaboratively with billing, coding, and clinical teams to correct errors and resubmit claims.
• Track and document denial trends, appeal success rates, and recovery efforts.
• Stay current with payer policies, coding guidelines, and reimbursement procedures.
• Recommend process improvements to reduce denial rates.
• Meet or exceed productivity and accuracy standards.
• Maintain confidentiality of patient and organization data.

Qualifications:

• High school diploma or GED required; Associate’s or Bachelor’s degree preferred.
• 2+ years of experience in medical billing, coding, or denials management.
• Strong knowledge of medical terminology, CPT, ICD-10, and HCPCS coding.
• Familiarity with payer-specific denial codes and appeal processes.
• Experience with billing software and Electronic Health Records (EHR) systems (e.g., Epic, Cerner, Athena).
• Excellent communication and problem-solving skills.
• Detail-oriented with strong organizational skills.

Preferred Certifications:

• Certified Professional Coder (CPC)
• Certified Revenue Cycle Specialist (CRCS)
• Certified Medical Reimbursement Specialist (CMRS)

Work Environment:

• Office-based or remote (depending on company policy)
• May require extended periods of computer use
• Fast-paced, deadline-driven

Job Type: Full-time

Pay: Rs50,000.00 - Rs100,000.00 per month

Work Location: In person