Key Responsibilities:
- End-to-end follow-up on insurance claims via phone calls and/or payer portals.
- Analyze and resolve denials and rejections received from payers (CARC/RARC codes interpretation).
- Perform root cause analysis and take corrective action for recurring denial trends.
- Ensure timely re-submission appeals and escalations for denied claims.
- Maintain accurate documentation of all activities performed in the billing system.
- Meet daily weekly and monthly productivity and quality benchmarks.
- Collaborate with billing coding and patient access teams to fix front-end issues causing denials.
- Work on denial worklists aging reports and assigned inventory efficiently.
- Maintain up-to-date knowledge of payer policies regulatory changes and industry best practices.
- Provide feedback to Team Leads/Supervisors on process gaps and potential improvement areas.
Required Skills & Qualifications:
- Minimum 2 years of experience in US Healthcare AR and Denial Management.
- Strong understanding of medical billing terminologies CPT/ICD codes and payer guidelines.
- Hands-on experience with billing platforms (Athena eClinicalWorks Epic In-Sync etc.) is preferred.
- Good understanding of HIPAA compliance and patient confidentiality.
- Strong communication skills verbal and written (especially for payer calls).
- An analytical and problem-solving mindset to investigate and resolve complex denials.
- Ability to work independently and collaboratively in a high-volume environment.
Additional Information :
All your information will be kept confidential according to EEO guidelines.
Remote Work :
No
Employment Type :
Full-time