About this role
Key Responsibilities:
• Identify, appeal, and reverse claims that are denied or underpaid inappropriately by payors. • Collaborate with departments such as Health Information Management (HIM), coding, and medical teams to gather necessary documentation for appeals. • Work proactively with multidisciplinary teams to create procedures that minimize denials through trend reporting and education. • Assist management with payor contract interpretation and ensure communication is updated for hospital staff. • Analyze and report data related to underpayments, denials, and revenue opportunities. • Categorize denials by root cause and share findings with management. • Act as a resource for billing and reimbursement issues as needed. • Stay informed about relevant regulations and maintain current knowledge in the field. • Execute special audit requests for denials and support the drafting of appeal letters. • Ensure smooth insurance operations through collaboration with colleagues. • Maintain strict confidentiality of medical records and data. • Provide support in medical coding and billing as necessary. • Perform additional duties as requested by management.
Qualifications:
• Bachelor’s degree in Para Medical, Accounting, or a related field. • Minimum of 3 years of experience, including 2 years in denial analysis and resubmission within a hospital or Day Surgical Centre setting. • Coding Certification from AHIMA or AAPC. • Experience with managed care contracts and reconciling patient accounts is highly desirable. • Proficient in written and spoken English.
If you are a dedicated professional committed to quality and efficiency, we encourage you to apply.
The submission deadline is Sunday, 4-May-2025. Only selected candidates will be contacted.