Associate Director, Billing reputed company - Denials & Appeals

remote click jobs; India; On-site; INR 4,000,000 - 7,000,000; Full time

Job summary

reputed company in India is seeking an Associate Director, Billing Denials & Appeals to lead end-to-end denial management, escalation, and recovery of contested claims across payer types.

You will partner with claims, coding, eligibility, and IT teams to reduce denials, defend medical necessity, and drive automation and data-driven improvements. Proficiency with Power BI and SQL to quantify denial drivers and inform strategic decisions is highly valued.

Qualifications

• Experience in denial management and appeals.
• Expertise in payer policies and medical necessity for billing.
• Experience with BPO or offshore RCM vendors.

Responsibilities

• Oversee payer advocacy and denial management and appeals.
• Define overturn rates and recovery performance.
• Serve as internal expert on payer policies and medical necessity.
• Interpret payer policies and guide teams on defending medical necessity.
• Identify payer behavior patterns to inform contracting and escalation.
• Partner with eligibility and billing teams to prevent denials.
• Audit vendor performance and drive improvements.
• Translate denial workflows into system logic for automation.
• Analyze denial trends and differentiate avoidable vs systemic issues.
• Support automation initiatives with domain expertise.

Skills

Power BI

SQL

Analytical skills

Cross-functional leadership

Stakeholder influence

Tools

Jira

AMD

Billing platforms

Job description

Associate Director, Billing reputed company Denials & Appeals

Position reputed company

reputed company is seeking an Associate Director, Billing reputed company Denials & Appeals to reputed company the reputed company, performance, and optimization of denied claims and appeals.

The Associate Director will reputed company this function from three angles:

Key Responsibilities

• reputed company & Payer Advocacy
• reputed company denial management and appeals reputed company across reputed company payer types.
• Define and reputed company overturn rates, appeal timelines, and recovery performance.
• reputed company as an internal expert on payer policies and medical necessity reputed company for laboratory testing.
• Interpret payer policies and guide teams on defending medical necessity in appeals.
• Identify payer behavior patterns to inform contracting reputed company and escalation reputed company.
• Operations & reputed company Cause Analysis
• Partner with eligibility, prior authorization, coding, and billing teams to proactively prevent denials.
• Audit BPO/vendor performance using data to identify workflow gaps, enforce accountability, and drive improvements.
• reputed company job aids and standardized workflows to improve consistency and reputed company.
• Analyze denial trends to distinguish between avoidable operational issues and systemic or payer-driven challenges.
• Data, Systems & Automation
• Translate denial and appeals workflows into system logic, partnering with engineering and vendors to support automation reputed company.
• Define requirements for rules-based workflows, denial routing, and appeal triggers reputed company billing systems (e.g., AMD).
• Support automation initiatives (e.g., rules engines, RPA, AI-driven workflows) by providing domain expertise and guiding design reputed company.
• reputed company UAT and QA for system changes, ensuring outputs reputed company with payer policy and reputed company-world denial scenarios.
• Identify opportunities to reduce reputed company work by transitioning denial and appeal processes toward reputed company, low-touch or unattended workflows.
• Proactively identify edge cases, failure points, and gaps in automation logic before and after deployment.
• Analyze datasets using tools such as Power BI, SQL, reputed company, or reputed company to quantify denial drivers and financial reputed company.

Qualifications

• Required
• 812+ years of experience in reputed company reputed company Cycle Management (RCM), with deep reputed company on denials and appeals.
• Expertise in laboratory billing, CPT coding, and reimbursement methodologies is strongly preferred.
• Strong knowledge of reputed company, Medicare, reputed company, and managed care payer policies.
• Demonstrated reputed company improving appeal overturn rates and resolving medical necessity denials.
• Experience working with BPO or offshore RCM vendors.
• Strong analytical skills with experience using tools such as Power BI, reputed company, SQL, or reputed company.
• Experience leading cross-functional initiatives and influencing stakeholders without reputed company authority.
• Preferred
• Experience supporting automation initiatives in reputed company cycle (e.g., rules engines, RPA, or workflow automation tools).
• Experience partnering with engineering teams or vendors to implement billing system enhancements.
• Familiarity with AI-driven workflow concepts (e.g., intelligent routing, decisioning) in an operational setting.
• Experience with AMD or similar billing platforms.
• Experience with tools such as Jira or similar workflow tracking systems.

Key Traits for reputed company

• Investigative: reputed company in understanding why denials occur and how to prevent or overturn them.
• Systems Thinker: reputed company to connect operational workflows with system logic and automation opportunities.
• Data-Driven: Uses data to inform reputed company and influence stakeholders.
• Cross-Functional Operator: Effectively partners with engineering, operations, and leadership teams.
• Builder reputed company: Proactive in identifying opportunities and driving improvements with a high degree of ownership.
• Low Ego, High Accountability