job description

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Responsibilities:

• Serve as a subject matter expert on denial management strategies and best practices.
• Lead the resolution of high-level and escalated denial issues.
• Conduct root cause analysis to identify systemic issues contributing to denials.
• Develop and implement proactive measures to prevent future denials.
• Establish and maintain relationships with payer representatives to facilitate effective communication and negotiation.
• Train and mentor junior associates on advanced denial management techniques and payer communication strategies.
• Collaborate with cross-functional teams to implement process improvements and optimize revenue cycle performance.
• Monitor denial trends and provide regular reports and updates to leadership.

Requirements:

• Bachelors degree in healthcare administration, finance, or related field.
• Minimum of 5 years of progressive experience in denial management or revenue cycle management.
• In-depth knowledge of healthcare billing regulations and payer policies.
• Excellent negotiation and relationship-building skills.
• Strong leadership and mentoring abilities.
• Advanced proficiency in data analysis and reporting tools.
• Ability to drive change and implement process improvements effectively.

• Investigate and resolve complex denial issues.
• Analyze AR/Denial trends to identify areas for process improvement.
• Initiate and lead payer calls for escalated denial inquiries and disputes.
• Develop and implement strategies to reduce denial rates and improve reimbursement.
• Collaborate with internal stakeholders to address root causes of denials.
• Mentor Level 1 associates on advanced denial management techniques.
• Prepare and submit appeals for denied claims as needed.
• Maintain comprehensive documentation of denial activities and outcomes.

Qualifacts is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.