Job Description:
Responsibilities:
Investigate and resolve complex denial issues.
Analyze denial trends to identify opportunities for process improvement.
Initiate and lead payer calls for escalated denial inquiries, follow-ups, and disputes.
Develop and implement strategies to reduce denial rates and enhance reimbursement.
Collaborate with internal stakeholders to address root causes of denials.
Prepare and submit appeals for denied claims as needed.
Maintain comprehensive documentation of denial activities and outcomes.
Address denials at the root cause by requesting appropriate rules and system edits after partner approval.
Identify and analyze denial trends and escalate to supervisor for further resolution.
Requirements:
Bachelor’s degree in any discipline.
Strong problem-solving and analytical skills and work towards resolution.
Candidates with 1-2 years of experience in Accounts Receivable (AR) & Denial Management
Qualifacts is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.
Skills Required
- Bachelor's degree in any discipline
- 1-2 years of experience in Accounts Receivable & Denial Management
What We Do
Qualifacts' CareLogic Enterprise Software is a comprehensive Electronic Health Record (EHR) designed for behavioral health, mental health, & human services.
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