Denial Multispecialty Quality Analyst

5 days ago

Hyderabad, India Sutherland Full time

Denial Multispecialty quality auditor:

  • Life science graduate is mandatory
  • Auditor should have 4+ years of experience in denial radiology, E/M IP and OP, surgery, IVR etc.
  • Able to analyze the denial trend and come up with solutions.
  • Need to provide education to the team and support the team wherever is required
  • Need to work independently. Should have good verbal and written communication
  • Should have knowledge in all the modalities and denial workflow
  • In depth knowledge about the payer policy and denial concepts NCCI edits, MEU, medical necessity.

Roles and Responsibilities: -

  • Responsible for accurately addressing multi-specialty denials which includes, EM OP, Surgery, Modifiers, Dx related and ensuring compliance with medical coding policies and guidelines.
  • Requires proficiency in ICD-10, CPT, and HCPCS coding systems, along with a strong understanding of medical terminology and anatomy.
  • Plays a critical role in optimizing reimbursement for healthcare services through timely and accurate submission of coded information.
  • Should have a good knowledge in denial codes and able to interpret the exact denial reasons from EOB and resolve it,

Desired Candidate Profile: -

  • Should be a Science Graduate.

  • Minimum of 1+ years of experience in Denials.

  • Basic knowledge of medical terminology and anatomy.

  • Comfortable to work from office.

  • Effective verbal and written communication skills (Should have capability to reply properly to client and stakeholders.
  • Successful completion of CPC or CCS certification must be active during joining and verified.
  • Able to work independently and willing to adapt and change as per business/ process requirements.

Timings & Transport

  1. Shift timings 8.30am 5.30Pm

  2. FIVE DAYS WORKING (MONDAY – FRIDAY)

  3. Need to be Comfortable with WFO-Work from office.

Perks and Benefits

  1. Saturday and Sunday Fixed Week Offs.

  2. Self-transportation bonus up to 3500per month.

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