Team Lead- Denials

3 days ago

Gurgaon, Haryana, India Commure Full time ₹ 15,00,000 - ₹ 25,00,000 per year

About the Role

Were seeking a Denials Team Lead with hands-on experience across both inpatient and outpatient denials to drive overturns, reduce aged inventory, and prevent recurrence at the root cause. Youll lead a pod of denial analysts, set daily priorities, coach for quality and speed, and collaborate with Coding, Charge Entry, Registration, and Payer Relations to improve first-pass yield and cash acceleration.

Key Responsibilities

Team Leadership & Delivery

  • Lead a team of denial analysts across IP/OP workqueues; plan capacity, assign work, and monitor performance.
  • Run daily huddles; set targets for productivity, quality, and TAT; remove blockers and manage escalations.
  • Conduct 1:1s, coaching, cross-training, and performance reviews.

Denials Resolution

  • Review EOB/ERA, CARC/RARC codes, payer policies, and medical necessity criteria to build strong appeals.
  • Oversee timely filing, resubmissions, corrected claims, and second-level medical appeals.
  • Drive overturns on common IP denials (e.g., level of care, lack of medical necessity, DRG changes) and OP denials (e.g., bundling, NCCI edits, MUEs, modifiers, prior auth).

Quality, Analytics & Prevention

  • Own team KPIs: denial-to-resolution TAT, aged bucket reduction (90/120), first-pass acceptance, and QA.
  • Perform root-cause analysis by payer/denial reason/service line; partner with Coding to fix upstream leakage.
  • Maintain SOPs and payer playbooks; run calibration with QA.

Compliance & Documentation

  • Ensure HIPAA compliance, accurate account notes, and audit-ready documentation.
  • Track and meet payer-specific TATs and timely filing limits.

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