Denial Management Associate

2 weeks ago

Mumbai Vikroli, India Harris Full time ₹ 2,00,000 - ₹ 6,00,000 per year

Business Unit:
Resolv was formed in 2022, bringing together a suite of industry-leading healthcare revenue cycle leaders with over 30 years of industry expertise, including Ultimate Billing, First Pacific Corporation, Innovative Healthcare Systems, and Innovative Medical Management. Our DNA is rooted in revenue cycle solutions. As we continue to expand, we remain dedicated to partnering with RCM companies that offer diverse solutions and address today's most pressing healthcare reimbursement and revenue cycle operations complexities. Together, we improve financial performance and patient experience, helping to build sustainable healthcare businesses.

Job Summary:

Denial Management Associate responsibility is to work on claims which include coding errors, duplicate claims, lack of medical necessity, patient eligibility issues, and insufficient documentation. A high denied-claims rate hurts a physician practice's financial bottom line because they are not getting payment for services rendered. Managing denials to decrease denial rates helps healthcare providers ensure they are billing medical services properly and receiving adequate payment for their services in a timely manner. Effective denials management can significantly improve the healthcare practice's financial health and patient satisfaction.

Work Mode: Work from Office
Shift Timings: 6pm to 3am (Night Shift)
Location: Mumbai

Primary Functions:

  • Knowledge of medical coding: Understanding HCPCS Level II, ICD-10-CM, and CPT codes and ensuring the codes support physician documentation will help prevent denials due to coding errors.
  • Understanding insurance policies: Professionals in this field need to understand different insurance policies, coverage details in the EOB, and the reasons why claims might be denied.
  • Analytical skills: The ability to analyze denial patterns and identify systemic issues is important for preventing future denials.
  • Communication skills: Strong written and verbal communication skills are essential. Denials managers need to communicate with insurance companies, healthcare providers, and sometimes patients.
  • Attention to detail: Given the complexity of medical billing and the potential for errors, attention to detail and investigating the reason for denials will help put an end to unnecessary denials.
  • Problem-solving skills: The ability to solve problems and find solutions is important, especially when it comes to overturning denied claims.
  • Knowledge of the revenue cycle: Understanding the entire revenue cycle will help to identify where issues are occurring, where the cash flow is bottlenecked, and how to fix it.

(Mandatory Qualifications & Skills):

  • Bachelor's degree in Accounting, Finance, Business Administration, or a related field (preferred).
  • 1-3 years of experience in accounts receivable, medical billing, or revenue cycle management.

Skills/ Behavioural Skills:

  • Problem-Solver: Identifies and resolves healthcare billing discrepancies.
  • Organized: Manages high volumes of medical remittances efficiently.
  • Clear Communicator: Effectively discusses payment issues with healthcare teams.
  • Analytical: Understands healthcare financial data and denial patterns.

Benefits:

  • Annual Public Holidays as applicable
  • 30 days total leave per calendar year
  • Mediclaim policy
  • Lifestyle Rewards Program
  • Group Term Life Insurance
  • Gratuity
  • more

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