Job Summary: A Senior Denial Analyst is responsible for analyzing and resolving denied medical insurance claims, identifying trends, and implementing strategies to minimize denials. This role involves collaborating with billing teams, insurance providers, and healthcare professionals to ensure timely claim resolution and maximize revenue recovery. The Senior Denial Analyst also plays a key role in process improvement and compliance with payer regulations. Key Responsibilities:Denial Management & Resolution: Review and analyze denied claims to determine the root cause. Help is enhancing our inhouse product. Work with insurance companies to appeal and resolve denied claims. Identify patterns in denials and recommend corrective actions. Follow up on outstanding denied claims to ensure timely resolution. Process Improvement & Compliance: Develop strategies to reduce future denials by improving documentation and coding accuracy. Ensure compliance with payer policies, Medicare, Medicaid, and other regulatory requirements. Stay updated with industry changes, reimbursement policies, and claim adjudication guidelines. Collaboration & Reporting: Work closely with billing, coding, and revenue cycle teams to address claim rejections. Provide training and guidance to junior analysts and billing staff on denial prevention. Generate reports on denial trends, recovery rates, and financial impacts. Present findings to senior management and recommend improvements. Qualifications & Skills:Education & Experience: 5+ years of experience in denial management, medical billing, or revenue cycle management. Experience with electronic health records (EHR), practice management systems, and payer portals . Technical Skills: Proficiency in ICD-10, CPT, HCPCS, and medical billing codes . Familiarity with payer-specific denial reasons and appeals processes. Experience with denial management software and revenue cycle analytics tools . Soft Skills: Strong analytical and problem-solving skills . Detail-oriented with the ability to manage multiple tasks efficiently. Show more Show less
Company Description Red Sky Health's mission is to ensure healthcare providers receive payments through automated remediation of health insurance claim denials. Our AI platform, Daniel, uses Machine Learning to analyze each denial, suggest real-time fixes, and automatically resubmit for approval and payment. Our vision is an environment where every healthcare claim denial is processed efficiently and accurately, allowing providers to focus more on patient care. Additionally, our program identifies opportunities for chronic care management, improving patient care, quality scores, and potential incentive payments. Role Description This is a full-time on-site role for certified medical coder, located in Ambattur. The specialist will be responsible for analysing denials die to coding issues and providing requirement to technology team to develop business solutions, managing health information, understanding medical terminologies, handling customer service inquiries, managing medical records, and overseeing the release of solutions and certify. Daily tasks include troubleshooting technical issues, ensuring operations, and facilitating communication between opertations and technology trammin USA Qualifications Health Information Management and Medical coding experience CPC certification Proficiency in Medical Terminology Customer Service skills and experience in handling inquiries Experience with Release of Information procedures Excellent communication and interpersonal skills Strong problem-solving abilities and technical aptitude Familiarity with multiple PMS systems Bachelor's degree