Medical Denial QA / QC Access Healthcare

3.0 - 8.0 years

4 - 9 Lacs

Chennai, Tamil Nadu, India

On-site

We are seeking a meticulous Medical Denial Quality Assurance (QA) / Quality Control (QC) specialist. The ideal candidate will possess strong expertise in denial management and medical billing processes, playing a critical role in reviewing and improving the accuracy of denial appeals and resolutions. This position is vital for optimizing revenue cycles and ensuring high-quality claim submissions. Key Responsibilities Perform QA/QC reviews of denied medical claims to identify root causes and coding/billing errors. Analyze denial trends and patterns to provide actionable insights for process improvements. Verify the accuracy of information used in appealing denied claims, including coding, documentation, and payer-specific guidelines. Collaborate with AR (Accounts Receivable) teams and coders to implement corrective actions and prevent future denials. Develop and deliver training sessions to enhance team knowledge on denial prevention and effective appeal strategies. Maintain comprehensive records of audit findings, corrective actions, and their impact on denial rates. Ensure adherence to industry regulations and compliance standards related to medical billing and denials. Qualifications Certification: Relevant coding or billing certification is preferred. Experience: Demonstrated experience in medical billing, AR follow-up , and denial management . Skills Strong analytical and problem-solving skills for complex denial scenarios. In-depth knowledge of medical billing cycles, claim submission processes, and payer guidelines . Excellent communication skills , both written and verbal, for reporting and collaboration. Proficiency in medical billing software and relevant office applications. Ability to work meticulously and identify subtle discrepancies in documentation.

Posted 1 day ago

Apply

Start Your Job Search Today

Browse through a variety of job opportunities tailored to your skills and preferences. Filter by location, experience, salary, and more to find your perfect fit.