denial management specialist

AppedologyPK Recruitment

Job Summary:We are seeking a detail-oriented and analytical professional to join our team as a Denial Management Specialist within the Medical/Behavioral Health domain. The primary responsibility of this role is to identify, analyze, and resolve claim denials to ensure accurate and timely reimbursement. The ideal candidate will possess a strong understanding of insurance processes, medical billing, and payer guidelines, particularly within behavioral health services. This position requires excellent problem-solving skills, attention to detail, and the ability to multitask effectively while maintaining a high level of accuracy and compliance. The candidate should also demonstrate strong communication abilities to coordinate with payers, clients, and internal teams for swift resolution of denied or underpaid claims.Key Responsibilities:<ul><li>Review and analyze denied or underpaid medical and behavioral health claims to determine root causes.</li><li>Work with insurance companies to resolve denials and ensure timely and accurate reimbursement.</li><li>Identify recurring denial trends and collaborate with billing and clinical teams to prevent future occurrences.</li><li>Prepare and submit appeals with appropriate supporting documentation in accordance with payer requirements.</li><li>Maintain detailed records of denial activities, appeal statuses, and resolutions in the billing system.</li><li>Communicate effectively with payers, clients, and internal departments to ensure issues are addressed promptly.</li><li>Monitor claim status and follow up proactively to reduce outstanding accounts receivable.</li><li>Ensure compliance with all HIPAA, payer, and organizational policies during all denial management processes.</li></ul>Requirements:<ul><li>High school diploma or equivalent; associate&rsquo;s or bachelor&rsquo;s degree in accounting, finance, or a related field is a plus.</li><li>Proven experience in billing, accounting, or administrative roles.</li><li>Strong attention to detail and numerical accuracy.</li><li>Proficiency in Microsoft Excel and billing/accounting software.</li><li>Excellent communication and organizational skills.</li><li>Ability to work independently and meet deadlines.</li></ul>Job Type: Full-time

Denial Management Specialist (MEDICAL BILLING US HEALTHCARE)

HRMD Solutions

IMPORTANT: Please read before applying&#9989; ONLY candidates with AR/ collections or Medical Billing will be considered.&#10060; Applicants without relevant healthcare experience (e.g., teaching, engineering, IT, sales, etc.) will be automatically rejected.Job Description:The AR Follow up Specialist will play a critical role in managing and collecting outstanding accounts receivable within the revenue cycle management process. This position requires fluency in English to effectively communicate with our diverse client base. The ideal candidate will have a strong background in collections within the healthcare industry in USA, exceptional communication skills, and the ability to work independently in a fast-paced environment.<ul><li>Full on site in Gulberg 3, Lahore</li><li>Night shifts only 6 pm- 3 am</li></ul>Key Responsibilities:<ul><li>Check eligibility and benefit verification by calls and web portals.</li><li>Review and verify medical codes, including CPT, ICD-10, and HCPCS.</li><li>Review and transmit corrected claims electronically or by paper according to the payers requirements.</li><li>Monitor and follow on unpaid or denied claims to ensure timely resolution.</li><li>Contact insurance companies to inquire about claims status and facilitate payment.</li><li>Review aging reports regularly to prioritize and address delinquent accounts.</li><li>Initiate apples, for denied or underpaid claims and track the appeal process.</li><li>Develop and implement denial management strategies to minimize future denials.</li><li>Main up-to-date documentation and detailed records of appeals.</li><li>Strong understanding of insurance policies, reimbursement methodologies and billing guidelines.</li><li>Collaborate with billing and coding teams to address recurring issues.</li><li>Investigate and resolve any discrepancies in payments, adjustments, or denials.</li><li>Identify claim processing issues and general billing trends.</li></ul>Qualifications:<ul><li>Bachelor&rsquo;s Degree from any reputed institute or University.</li><li>1 to 2 years&rsquo; Experience in Medical Billing- Accounts receivable and denial management.</li><li>Knowledge and understanding of USA health insurance guidelines especially Medicare and state Medicaid</li><li>Experience to work on Pain Management, Anesthesia, Psych/ TMS, RTM, CCM.</li></ul>Job Type: Full-timeJob Type: Full-timePay: Rs85,000.00 - Rs125,000.00 per monthApplication Question(s):<ul><li>Do you live in Lahore?</li><li>Are you willing to work Night shift (on-site)?</li></ul>Work Location: In person

AR Specialist

Aegan Technologies Private Limited

Role: Senior AR CallerWork location: Pondicherry (Work from Office)Mode of interview: Both Virtual and in personPrerequisites:<ul><li>1-6 years of experience in AR Calling (Denial management)</li><li>Immediate joiners are preferred (Notice period up to 1 month is admissible)</li></ul>Job Description:<ul><li>Responsible for calling Insurance companies (in US) on behalf of doctors/physicians and follow up on outstanding Accounts Receivable.</li><li>To prioritize the pending/overdue tasks for calling/working from the aging basket.</li><li>Should be able to convince the claims company (payers) for reprocessing the claims for payment of their outstanding claims.</li><li>To check the appropriateness of the demographic/insurance information given by the patient if it is inadequate or unclear.</li><li>To make a physical call by following the international norms and applicable rules for confidentiality and HIPAA compliance.</li><li>Escalate difficult collection situations to the teams supervisors in a timely manner.</li><li>Review provider claims that have not been paid by insurance companies or denied by the insurance companies.</li><li>Handling patients billing queries and updating their account information.</li><li>Working on denied claims by taking the appropriate action</li><li>Routing denials to the correct department in case of fix the hole opportunities</li><li>Escalate all avoidable denials to the teams supervisors where there is a direct revenue loss for the practice and the company.</li><li>Sharing new findings with the teams supervisors and the team</li><li>Post cash and write off the contractual adjustments accordingly while working on the accounts.</li><li>Meeting daily/weekly and monthly targets set for an individual.</li></ul>Desired Profile:<ul><li>Should be willing to work in US Shift.</li><li>Experience in Denial Management (Healthcare Revenue Cycle Management) process.</li><li>Strong written and verbal communication skills.</li><li>Good computer skills including Microsoft Office suite.</li><li>Ability to prioritize and manage work queue.</li><li>Ability to work independently as well as in a team environment.</li><li>Should be a result oriented person and works towards solving the issues instead of dragging the issues.</li><li>Strong analytical and problem-solving skills.</li><li>Good typing skills with a speed of min 30-35 words /mi. Role &amp; responsibilities</li></ul>Perks and benefits:<ul><li>Competitive Salary</li><li>Subsidized Dinner</li><li>Pick up and Drop Cab facility</li></ul>Interested Candidates Apply at : Ashika@aegan-global.com /9677254444Job Type: Full-timePay: &#8377;8,086.00 - &#8377;29,434.98 per monthBenefits:<ul><li>Food provided</li></ul>Work Location: In person

AR Caller

Omega Healthcare Management Services Pvt. Ltd..

Executive AR Caller / Senior Executive (AR Calling)<ul><li>Should handle US Healthcare providers/ Physicians/ Hospital's Accounts Receivable.</li><li>To work closely with the team leader.</li><li>Ensure that the deliverables to the client adhere to the quality standards.</li><li>Responsible for working on Denials, Rejections, LOA's to accounts, making required corrections to claims.</li><li>Calling the insurance carrier &amp; Document the actions taken in claims billing summary notes.</li><li>To review emails for any updates</li><li>Identify issues and escalate the same to the immediate supervisor</li><li>Update Production logs</li><li>Strict adherence to the company policies and procedures.</li><li>Sound knowledge in Healthcare concept.</li><li>Should have 1 Yr to 5 Yrs of AR calling Experience.</li><li>Excellent Knowledge on Denial management.</li><li>Understand the client requirements and specifications of the project</li><li>Should be proficient in calling the insurance companies.</li><li>Ensure targeted collections are met on a daily / monthly basis</li><li>Meet the productivity targets of clients within the stipulated time.</li><li>Ensure accurate and timely follow up on pending claims wherein required.</li><li>Prepare and Maintain status reports</li></ul>Kindly contact - 93633 39512 / Mayuri.Jayakumar@omegahms.comJob Type: Full-timePay: &#8377;240,000.00 - &#8377;450,000.00 per yearWork Location: In person

Executive / Senior AR Caller

MaxRemind

Job Title: Medical Billing Specialist &amp; Reporting AnalystJob Summary:We are seeking a Medical Billing Specialist &amp; Reporting Analyst to manage end-to-end billing operations and ensure accuracy in claims submission, payment posting, and reporting. The ideal candidate will have strong analytical skills, proficiency in Excel, and a deep understanding of the US healthcare billing process.Key Responsibilities:<ul><li>Prepare, review, and submit medical claims to insurance companies accurately and timely.</li><li>Monitor claim rejections and denials; identify root causes and ensure prompt resolution.</li><li>Post payments and reconcile accounts to ensure proper posting in the system.</li><li>Generate and maintain daily, weekly, and monthly performance reports related to billing and collections.</li><li>Track KPIs such as claim submission accuracy, denial rates, and payment turnaround times.</li><li>Perform data analysis to identify trends and provide insights for process improvement.</li><li>Maintain confidentiality and compliance with HIPAA and company policies.</li></ul>Requirements:<ul><li>Familiarity with EHR/PM systems and payer portals.</li><li>Strong analytical and communication skills.</li><li>Detail-oriented, organized, and able to meet deadlines.</li><li>Bachelor&rsquo;s degree (preferably in Business, Finance, Healthcare, or related field).</li><li>6 months to 1.5 years of experience in US medical billing and reporting.</li></ul>Job Type: Full-TimeTimings: 8:00 PM &ndash; 5:00 AMLocation: Old Airport Road, Fazal Town phase 2, RawalpindiJob Type: Full-timePay: Rs40,000.00 - Rs50,000.00 per monthWork Location: In person

Medical Billing Specialist and Analyst

Paritas Nexus

Company: NEXT RCM Location: Remote (USA-based clients) Position: Senior DME Medical Biller Experience Required: 6&ndash;7 Years (DME Billing &amp; RCM)About the Role: NEXT RCM is seeking an experienced Senior DME Medical Biller to join our growing team. The ideal candidate must have in-depth knowledge of Durable Medical Equipment (DME) billing, claim submission, denial management, and insurance follow-ups for US-based healthcare clients.Key Responsibilities:<ul><li>Manage complete DME billing cycle (charge entry, claim submission, payment posting, denial handling).</li><li>Work with insurance portals for eligibility, claim status, and appeals.</li><li>Ensure accuracy and compliance with payer guidelines.</li><li>Train and guide junior billing staff when required.</li><li>Communicate effectively with clients and internal teams.</li></ul>Requirements:<ul><li>Minimum 6&ndash;7 years of experience in DME medical billing.</li><li>Strong understanding of HCPCS codes, modifiers, and payer requirements.</li><li>Experience with RCM software and clearinghouses.</li><li>Excellent communication and analytical skills.</li><li>Ability to work independently in a remote environment.</li></ul>What We Offer:<ul><li>Remote working flexibility.</li><li>Competitive compensation package.</li></ul>Job Types: Full-time, Part-timeWork Location: Remote

Senior DME Medical Biller

Speak Viral

We seek a qualified and dedicated AR Specialist to join our administrative office. In this position, you will be responsible for analytical tasks related to debt collection, and invoicing. The role involves ensuring accurate and timely billing, resolving payment issues, managing accounts receivable, and maintaining financial records.Key Responsibilities:<ul><li>Submit and track medical claims to insurance companies Ensure claims are accurate and comply with payer requirements.</li><li>Record payments and adjustments into the billing system.</li><li>Review and address claim denials and rejections by analyzing the reasons for denial, correcting issues, and resubmitting claims.</li><li>Follow up on outstanding accounts.</li><li>Reconcile accounts to ensure all payments, adjustments, and write-offs are accurately recorded.</li><li>Prepare and review reports on accounts receivable.</li><li>Ensure that all billing practices comply with healthcare policies.</li></ul>Skills and Qualifications:<ul><li>Accurate data entry and meticulous record-keeping are crucial.</li><li>Understanding codes for claim submissions and denials.</li><li>Ability to effectively communicate with insurance companies.</li><li>Capable of analyzing financial data and identifying discrepancies or patterns.</li><li>Familiarity with billing software.</li></ul>Education and Experience:<ul><li>Bachelor&rsquo;s degree in business, health care administration, accounting, or a relevant field.</li><li>A minimum of 2 years of experience as a medical biller.</li><li>Previous experience in medical billing or a related field is required, with experience in AR management</li></ul>Benefits:<ul><li>Free Meal</li><li>Market Comparative Salary</li><li>Paid Holidays</li><li>Provident Fund</li><li>Career Growth</li><li>Annual, Bi-Anual Increments</li></ul>Job Type: Full-timePay: Rs40,000.00 - Rs80,000.00 per monthApplication Question(s):<ul><li>Will you be able to work in night shift(6pm to 3am)?</li><li>Will you be able to commute to Bahria Town Phase 7 Rawalpindi?</li></ul>Work Location: In person

AR Specialist in Medical Billing

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