Job Description

Designation: SME - Denial Management

Experience: 2-3 years

Skills desired:
o?Detailed knowledge of US healthcare billing cycle
o?Experience working with different EMR/EHR systems like Epic, Cerner, Allscripts, Athenahealth, NextGen, eClinicalWorks, Meditech, etc.
o?Denial analysis and management

Review and analyze denied insurance claims to identify cause of denials such as coding issues, preauthorization, payer-specific policies Develop and track denial log to monitor patterns and trends in denied claims Experience talking with payers to obtain clarification with denials and initiate timely appeals when appropriate Expertise in working with denial reason codes (CARC, RARC) and identifying root causes of denials. Strong understanding of billing regulations, CPT, ICD-10, HCPCS codes, and compliance standards (HIPAA, CMS guidelines).
o?Appeals

Understand 1st, 2nd, 3rd, and External Level Appeal process, system, and documentation SOP Prepare, submit, and follow up on appeals ensuring all necessary documentation is included
- Revie Review assigned denials and EOB's for appeal filing information. Gather any missing information
- Review case history, payer history, and state requirements to determine appeal strategy
- Obtain patient and/or physician consent and medical records when required by the insurance plan or state
- Gather and fill out all special appeal or review forms
- Create appeal letters, attach the materials referenced in the letter, and mail them

Maintain a record of all appeals and responses to track appeal outcomes and recovery rates Monitor payer response timelines to ensure appeal filing deadlines are met Track insurance company and state requirements and denial trend changes
Job Types: Full-time, Permanent

Benefits:

Leave encashment Provident Fund
Schedule:

Rotational shift
Experience:

Denial Management: 2 years (Preferred)
Work Location: In person

Application Deadline: 10/08/2025