Key Responsibilities Denial Management & Appeals Review denied and underpaid insurance claims and initiate appropriate resubmissions and appeals. Investigate reimbursement discrepancies and contractual variances. Prepare clear, accurate, and evidence-based appeal submissions. Support the resolution of complex billing and reimbursement issues. Documentation & Collaboration Work closely with Coding, Health Information Management, Finance, and Clinical teams to obtain supporting documentation for claims appeals. Coordinate with internal stakeholders to ensure efficient claims processing. Assist with medical coding and billing activities when required. Revenue Integrity & Analytics Analyze denial trends, underpayments, and revenue leakage opportunities. Perform root cause analysis and recommend corrective actions. Generate reports and metrics to support performance improvement initiatives. Support revenue optimization through data-driven insights. Process Improvement Collaborate with multidisciplinary teams to reduce recurring denials. Contribute to workflow enhancements and denial prevention strategies. Participate in special projects and continuous improvement initiatives within Revenue Cycle Management. Compliance & Governance Ensure compliance with payer guidelines, healthcare regulations, and hospital policies. Maintain strict confidentiality of patient and organizational information. Support organizational objectives through adherence to quality and compliance standards.

Qualifications:Education Bachelor's Degree in Paramedical Sciences, Accounting, Healthcare Administration, or a related field. Professional Coding Certification from AHIMA or AAPC highly advantageous Experience Minimum 3 years of relevant experience, including at least 2 years in denial analysis and claims resubmission within a hospital or day surgery center. Experience with managed care contracts, reimbursement reconciliation, and contract rate analysis is highly desirable. Skills & Competencies Strong understanding of medical billing, coding, claims processing, and insurance reimbursement. Ability to read and interpret medical records and clinical documentation. Excellent analytical and problem-solving skills with experience in root cause analysis. Strong attention to detail and ability to identify denial trends. Proficiency in Microsoft Office applications, particularly Excel. Effective communication and stakeholder management skills. Ability to manage multiple priorities in a fast-paced healthcare environment. High level of professionalism, integrity, and confidentiality. Self-motivated with a continuous improvement mindset
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