The Role
Investigate and resolve complex AR denials, analyze trends, lead payer escalations, prepare appeals, mentor junior associates, and implement strategies to reduce aging and improve reimbursement.
Summary Generated by Built In
Job Description:
Responsibilities:
- Investigate and resolve complex AR/Denial issues.
- Analyze 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 Aging & Denial rates and improve reimbursement.
- Collaborate with internal stakeholders to address root causes of denials.
- Mentor Level 1 associates on advanced AR/Denial management techniques.
- Prepare and submit appeals for denied claims as needed.
- Maintain comprehensive documentation of denial activities and outcomes.
Requirements:
- Associate degree in healthcare administration or related field (preferred).
- Minimum of 2 years of experience in denial management or revenue cycle management.
- Proficiency in medical billing software and denial tracking systems.
- Strong problem-solving and analytical skills.
- Ability to effectively communicate with payers to negotiate claim resolutions.
- Leadership skills and ability to work independently.
Qualifacts is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.
Skills Required
- Associate degree in healthcare administration or related field
- Minimum of 2 years of experience in denial management or revenue cycle management
- Proficiency in medical billing software and denial tracking systems
- Strong problem-solving and analytical skills
- Ability to effectively communicate with payers to negotiate claim resolutions
- Leadership skills and ability to work independently
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The Company
What We Do
Qualifacts' CareLogic Enterprise Software is a comprehensive Electronic Health Record (EHR) designed for behavioral health, mental health, & human services.






