Denial Management - U.S. Healthcare

Job Description: Denial Management- U.S. Healthcare

Location: Pune (Candidates Only)

Work Mode: Permanent Work From Home

Shift Timing: U.S. Shift (Night Shift)

Employment Type: Full-Time

Experience Required: 1.5 to 3 Years

Joining: Immediate Joiners Preferred

Communication: Excellent written and verbal communication skills required

Position Summary

The Denial Management Executive will be responsible for analyzing, managing, and resolving claim denials for U.S. healthcare clients. The role focuses on reducing denial rates, ensuring timely follow-ups, and maximizing revenue recovery by coordinating with internal teams, payers, and providers.

Key Responsibilities

• Analyze and work on denied claims across various payers in the U.S. healthcare system.
• Identify root causes of denials and take corrective actions to prevent recurrence.
• Submit appeals and reconsiderations with accurate documentation within payer timelines.
• Follow up with insurance companies to resolve denials and secure claim payments.
• Maintain detailed records of denial trends and outcomes for reporting purposes.
• Collaborate with coding, billing, AR, and eligibility teams to resolve complex issues.
• Ensure compliance with HIPAA and payer-specific guidelines.
• Meet productivity, quality, and turnaround time (TAT) benchmarks.
• Provide feedback and insights to improve first-pass resolution rates.

Core Competencies

• Strong knowledge of U.S. healthcare revenue cycle management (RCM) .
• Having Prior experience in ABA = Applied Behavior Analysis (Behavioral Health Billing & Revenue Workflow) would be an advantage
• Expertise in denial management and appeals processes .
• Understanding of CPT, ICD-10, and HCPCS coding basics .
• Familiarity with EOBs, ERAs, and VOBs, payer portals .
• Analytical and problem-solving skills with attention to detail.
• Ability to prioritize tasks and manage high-volume workloads.
• Excellent written and verbal communication skills for payer interaction.
• Proficiency in healthcare billing systems and MS Excel.
• Ability to work independently in a remote environment.

To Apply:

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Note: Candidates must apply only through LinkedIn or email by sending their updated resume.

• Resumes sent via WhatsApp will not be accepted or entertained under any circumstances.