Denials management Specialist

Healthcare Informatics Pvt. Ltd.; United States; Remote; USD 60,000 - 90,000; Full time

Job summary

Healthcare Informatics is seeking an experienced denial management professional to oversee the appeals process for denied claims in the US healthcare system. You will analyze EOBs, identify root causes, and coordinate with providers and insurers to resolve issues and improve cash flow.

The role requires 5–15 years in US healthcare, strong data analysis skills, and excellent communication to collaborate with cross-functional teams and drive process improvements.

Qualifications

• 5-15 years of experience in US healthcare, preferably in denial management.
• Strong understanding of appeals process and related billing regulations.
• Proficiency in analyzing data sets to identify trends in denial rates.
• Excellent communication for collaboration with cross-functional teams.

Responsibilities

• Manage appeals process from start to finish, ensuring timely resolution of denied claims.
• Identify root causes of denials through analysis of EOBs and provider feedback.
• Collaborate with internal stakeholders to resolve rejections and optimize AR calling strategies for improved cash flow.
• Develop and maintain communication channels with providers, insurers, and other parties.

Skills

Denial management

Data analysis

Communication

Cross-functional collaboration

Job description

Roles and Responsibilities :

• Manage appeals process from start to finish, ensuring timely resolution of denied claims.
• Identify and address root causes of denials through thorough analysis of EOBs (Explanation of Benefits) and provider feedback.
• Collaborate with internal stakeholders to resolve rejections and optimize AR calling strategies for improved cash flow.
• Develop and maintain effective communication channels with providers, insurance companies, and other relevant parties.

Job Requirements :

• 5-15 years of experience in US healthcare industry, preferably in denial management or related field.
• Strong understanding of appeals process, including regulations and guidelines governing medical billing practices.
• Proficiency in analyzing complex data sets to identify trends and areas for improvement in denial rates.
• Excellent communication skills for effective collaboration with cross-functional teams.