Rejections Specialist

Ventra Health, Inc.; Hyderabad; On-site; INR 350,000 - 720,000; Full time

Job summary

Ventra Health, Inc. is seeking a Rejections Specialist in Hyderabad to analyze collections, resolve non‑payables, and handle bill inquiries for complex issues. You will follow up on payer denials and ensure claims are paid per client contracts, while adhering to billing standards.

Two years’ experience posting insurance payments and reading EOBs preferred; offshore engagement experience is desirable. Base compensation and a discretionary bonus apply.

Qualifications

• Knowledge of medical billing rules including COB, modifiers, and EOBs.
• Proficiency with billing software and timely posting of payments.
• Ability to read and apply state/federal regulations.
• Strong communication and time‑management skills.

Responsibilities

• Follows up on claim rejections and denials to ensure appropriate reimbursement.
• Process assigned AR work lists in a timely manner.
• Write appeals to resolve denials with a goal of one contact resolution.
• Identify and resolve denied, non‑paid, or non‑adjudicated claims due to coverage issues.
• Recommend accounts to be written off on Adjustment Requests.
• Review and respond to insurance company inquiries and status updates.
• Navigate websites to obtain EOBs and document follow‑ups.
• Meet production and quality standards as set by Ventra Health.

Skills

Medical billing

EOB interpretation

Insurance follow‑up

offshore engagement

Communication

Time management

Organization

Education

High School Diploma or Equivalent

Tools

Billing software

Job description

Job Summary

• The Rejections Specialist is primarily responsible for analyzing collections, resolving non‑payables, and handling bill inquiries for more complex issues. Specialists are responsible for insurance payer follow‑up ensuring claims are paid according to client contracts. Complies with all applicable laws regarding billing standards.

Essential Functions and Tasks

• Follows up on claim rejections and denials to ensure appropriate reimbursement for our clients.
• Process assigned AR work lists provided by the manager in a timely manner.
• Write appeals using established guidelines to resolve claim denials with a goal of one contact resolution.
• Identified and resolved denied, non‑paid, and/or non‑adjudicated claims and billing issues due to coverage issues, medical record requests, and authorizations.
• Recommend accounts to be written off on Adjustment Request.
• Reports address and/or filing rule changes to the manager.
• Check the system for missing payments.
• Properly notates patient accounts.
• Review each piece of correspondence to determine specific problems.
• Research patient accounts.
• Reviews accounts and determines appropriate follow‑up actions (adjustments, letters, phone insurance, etc.).
• Processes and follows up on appeals. Files appeals on claim denials.
• Inbound/outbound calls may be required for follow‑up on accounts.
• Respond to insurance company claim inquiries.
• Communicates with insurance companies about the status of outstanding claims.
• Meet established production and quality standards as set by Ventra Health.
• Navigate websites to obtain EOBs.
• Performs special projects and other duties as assigned.

Education and Experience Requirements

• High School Diploma or Equivalent.
• Two (2) years of experience posting insurance payments in a healthcare setting.
• Two (2) years of experience reading insurance Explanation of Benefits (EOB) statements preferred.
• AAHAM and/or HFMA certification preferred.
• Experience with offshore engagement and collaboration desired.

Knowledge, Skills, and Abilities

• Intermediate level knowledge of medical billing rules, such as coordination of benefits, modifiers, Medicare, and Medicaid, and understanding of EOBs.
• Become proficient in the use of billing software within 4 weeks and maintain proficiency.
• Ability to read, understand and apply state/federal laws, regulations, and policies.
• Ability to communicate with diverse personalities in a tactful, mature, and professional manner.
• Ability to remain flexible and work within a collaborative and fast‑paced environment.
• Strong balancing and reconciliation skills.
• Strong 10 Key calculator skills.
• Strong oral, written, and interpersonal communication skills.
• Strong mathematical skills.
• Strong time management skills.
• Strong organizational skills.

Compensation

• Base Compensation will be based on various factors unique to each candidate including geographic location, skill set, experience, qualifications, and other job‑related reasons.
• This position is also eligible for a discretionary incentive bonus in accordance with company policies.

Ventra Health

Equal Employment Opportunity (Applicable only in the US) Ventra Health is an equal opportunity employer committed to fostering a culturally diverse organization. We strive for inclusiveness and a workplace where mutual respect is paramount. We encourage applications from a diverse pool of candidates, and all qualified applicants will receive consideration for employment without regard to race, color, ethnicity, religion, sex, age, national origin, disability, sexual orientation, gender identity and expression, or veteran status. We will provide reasonable accommodations to qualified individuals with disabilities, as needed, to assist them in performing essential job functions.