Denial Multispecialty Quality Analyst

Denial

• Life science graduate is mandatory

• Auditor should

  have 4+ years of experience in denial radiology, E/M IP and OP, surgery, IVR etc.

• Able to analyze the denial trend and come up with solutions.

• Need to provide education to the team and support the team wherever is required

• Need to work independently. Should have good verbal and written communication

• Should have knowledge in all the modalities and denial workflow

• In depth knowledge about the payer policy and denial concepts NCCI edits, MEU, medical necessity.

Roles and Responsibilities: -

• Responsible for accurately addressing multi-specialty denials which includes, EM OP, Surgery, Modifiers, Dx related and ensuring compliance with medical coding policies and guidelines.
• Requires proficiency in ICD-10, CPT, and HCPCS coding systems, along with a strong understanding of medical terminology and anatomy.
• Plays a critical role in optimizing reimbursement for healthcare services through timely and accurate submission of coded information.
• Should have a good knowledge in denial codes and able to interpret the exact denial reasons from EOB and resolve it,

Desired Candidate Profile: -

• Should be a Science Graduate.

• Minimum of 1+ years of experience in Denials.

• Basic knowledge of medical terminology and anatomy.

• Comfortable to work from office.
• Effective verbal and written communication skills (Should have capability to reply properly to client and stakeholders.
• Successful completion of CPC or CCS certification must be active during joining and verified.
• Able to work independently and willing to adapt and change as per business/ process requirements.

Timings & Transport

1. Shift timings 8.30am – 5.30Pm

2. FIVE DAYS WORKING (MONDAY – FRIDAY)

3. Need to be Comfortable with WFO-Work from office.

Perks and Benefits

1. Saturday and Sunday Fixed Week Offs.

2. Self-transportation bonus up to 3500per month.