Medical Denial QA

4 weeks ago


Chennai, Tamil Nadu, India Access Healthcare Full time
Job Description

We are seeking a meticulous Medical Denial Quality Assurance (QA) / Quality Control (QC) specialist. The ideal candidate will possess strong expertise in denial management and medical billing processes, playing a critical role in reviewing and improving the accuracy of denial appeals and resolutions. This position is vital for optimizing revenue cycles and ensuring high-quality claim submissions.

Key Responsibilities

- Perform QA/QC reviews of denied medical claims to identify root causes and coding/billing errors.
- Analyze denial trends and patterns to provide actionable insights for process improvements.
- Verify the accuracy of information used in appealing denied claims, including coding, documentation, and payer-specific guidelines.
- Collaborate with AR (Accounts Receivable) teams and coders to implement corrective actions and prevent future denials.
- Develop and deliver training sessions to enhance team knowledge on denial prevention and effective appeal strategies.
- Maintain comprehensive records of audit findings, corrective actions, and their impact on denial rates.
- Ensure adherence to industry regulations and compliance standards related to medical billing and denials.

Qualifications

- Certification: Relevant coding or billing certification is preferred.
- Experience: Demonstrated experience in medical billing, AR follow-up, and denial management.

Skills

- Strong analytical and problem-solving skills for complex denial scenarios.
- In-depth knowledge of medical billing cycles, claim submission processes, and payer guidelines.
- Excellent communication skills, both written and verbal, for reporting and collaboration.
- Proficiency in medical billing software and relevant office applications.
- Ability to work meticulously and identify subtle discrepancies in documentation.

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