Medical Denial Quality Review Professional

3 days ago


Chennai, Tamil Nadu, India beBeeAnalytical Full time ₹ 9,00,000 - ₹ 12,00,000
Medical Denial Quality Assurance Specialist

We are seeking a meticulous Medical Denial Quality Assurance (QA) / Quality Control (QC) professional to play 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 rigorous 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 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 and Qualities:
  • 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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