Denials & Claims Resolution Specialist (Salary: 15k-25k/month)

3 days ago

Jaipur, India PayRight Solutions Full time

Job Summary

We are seeking a Denials & Claims Resolution Specialist
to join our diagnostic laboratory's Revenue Cycle team. In this role, you will be responsible for managing claim rejections, denials, and billing issues with speed, accuracy, and persistence. Working directly within our
Laboratory Information System (LIS)
and the
Waystar clearinghouse
, you will investigate, resolve, and resubmit claims to optimize reimbursement and reduce revenue leakage.

The ideal candidate is
resourceful, analytical, and action-oriented
, with a strong understanding of insurance payer requirements, denial codes, and appropriate resolution strategies. You'll work in close partnership with internal teams and external payers while meeting key performance indicators (KPIs) related to productivity, turnaround time, and resolution accuracy.

Key Responsibilities

·       Utilize Laboratory Information System (LIS)
and
Waystar clearinghouse tools
to research, track, and resolve claim denials and rejections.

·       Analyze insurance payer denial reasons and take appropriate, timely actions such as claim correction, documentation submission, resubmission, or appeal.

·       Clarify denial causes and ensure resolution pathways are accurate and efficient.

·       Maintain a working knowledge of payer-specific rules, denial trends, rejection codes, and resolution timelines.

·       Correct and resubmit rejected or denied claims quickly and within company policy and guidelines.

·       Document claim status, payer communication, and resolution steps clearly and accurately in the billing and clearinghouse systems.

·       Identify and report recurring denial trends and system or process breakdowns to Revenue Cycle leadership for further action.

·       Collaborate with the internal teams to resolve registration or demographic errors impacting claims.

·       Participate in performance review meetings and denial trend analysis to ensure continuous improvement in denial prevention strategies.

·       Meet established KPIs for productivity, turnaround time, and quality assurance.

·       Ensure all actions are performed in full compliance with HIPAA and organizational policies.

·       Assist with other billing, reconciliation, or appeals tasks as assigned.

What You Bring

Required:

  • College Graduate.
  • Experience in medical billing, focused on claim rejection and denial resolution for a diagnostic lab setting.
  • Proficiency in Microsoft Office (Word, Excel, Outlook).
  • Strong written and verbal communication skills.
  • High attention to detail and strong organizational skills.
  • Ability to work independently with a sense of urgency and accountability.
  • Understanding of the end-to-end Revenue Cycle process.

Preferred Skills:

  • Experience with patient registration workflows and systems.
  • Workers' compensation billing or registration experience.
  • Laboratory billing environment.
  • Insurance payers.
  • Identifying trends and contributing to denial prevention strategies

Performance Expectations

  • Productivity:
    Consistently meets or exceeds claims processed and resolved daily/weekly.
  • Quality:
    Maintains high accuracy in claim corrections and documentation.
  • Communication:
    Effectively collaborates with internal teams and leadership.
  • Problem-Solving:
    Quickly identifies root causes and drives resolution.

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