Job Description

Job Description

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.