Denials Management

Job Overview:

We seek an experienced and highly motivated Denials Specialist to join our team. The Denials

Specialist will be responsible for handling denied claims making outbound calls to insurance

payers and resubmitting corrected claims. The ideal candidate should possess excellent

communication and problemsolving skills have a strong understanding of medical billing and

coding and be wellversed in denial management and appeals processes.

Role & responsibilities

Denial Identi cation and Analysis: Identify categorize and analyze denials and

underpayments from Explanation of Bene ts (EOBs) and Electronic Remittance Advice

(ERAs).

Claim Resubmission and Appeals: Correct and resubmit denied claims or prepare and

submit appeals following payer guidelines and timelines.

Payer Communication: Communicate with insurance companies to resolve issues leading

to denials and ensure accurate reimbursement.

Preventative Action: Review denial trends and work with other RCM teams to implement

processes that can prevent future denials.

Experience in analyzing and resubmitting Denials in multiple specialities (Denials due to

Medical Coding Authorisation etc).

Preferred candidate pro le

16 years of prior experience in denials management healthcare billing or a related role.

Strong understanding of medical billing processes payer requirements and CARC/RARC

codes.

Excellent problemsolving and negotiation skills.

Detailoriented with strong analytical skills.

Excellent communication skills both written and verbal.

Pro ciency in using healthcare billing software and Microsoft O ce Suite.