Director of Denial Resolution and Process Improvement

5 days ago


Hyderabad, Telangana, India PrimEra Medical Technologies Full time
About the Role

We are seeking an experienced Director to lead our Denial Resolution and Process Improvement team at PrimEra Medical Technologies.

Job Description:

This is a critical role that requires strong leadership and analytical skills. As the Director, you will be responsible for overseeing the day-to-day operations of the appeals staff, including inflow monitoring, work assignment, reviewing employee time records, and providing feedback to supervisors on employee performance.

You will also develop and implement unit goals and objectives, new and revised programs, work plans, systems, policies, processes, procedures, and methods of operation. This includes assigning work activities, projects, and program responsibilities, monitoring workflow, and reviewing and evaluating work products, methods, and procedures.

In addition, you will monitor work queues, including deploying users to areas of greatest need, and provide analysis and recommendations for improving appeals and follow-up processes. You will also engage in real-time performance monitoring to facilitate achievement of service level agreement requirements.

Your expertise will be utilized to create logic based on denial patterns, consolidate denials from 837 and Appeals Data, and analyze reasons for denials. You will work with the Front-End Operations Team and notify if any fall outs and gaps to be filled, and come up with logics to prevent denials.

You will develop strategies for quality improvement by mitigating errors, train new employees, and respond quickly to facility/BO queries to fix issues within timelines. You will also explore automation opportunities and assess their feasibility for effective implementation.

The ideal candidate will have experience with payer-wise denial trends, suggest additions/revisions/deletions to work queues to improve efficiency and reduce denials, identify denial patterns, escalate to management as appropriate with sufficient information for additional follow-up, and/or root cause resolution.

You will be available to team members to clarify queries, collect data, perform statistical analysis, interpretation, and presentation using dashboards. You will participate in meetings with facilities, billing offices, and work towards quick resolution for query accounts.

This is a challenging role that requires excellent communication, organizational, and time management skills. If you are a motivated and results-driven individual with a passion for process improvement, we encourage you to apply.

What We Offer:
  • A competitive salary: $120,000 - $150,000 per annum, commensurate with experience
  • An opportunity to work with a dynamic team in a rapidly growing company
  • A comprehensive benefits package, including health insurance, retirement savings plan, and paid time off


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