AR Analyst – Denial with Hospital Billing (Day shift)
Job Summary
The Denial Management Specialist focuses on analyzing, appealing, and preventing claim denials to optimize reimbursement and reduce recurring revenue loss.
Qualifications
- 3–5 years hospital denial management experience
- Strong knowledge of ICD-10, CPT, DRG validation
- Experience with CMS appeals levels (Redetermination, Reconsideration)
- Strong analytical and writing skills
Key Responsibilities
- Review denial codes (CARC/RARC).
- Categorize denials: Clinical, Technical, Administrative.
- Identify root causes and trends.
- Prepare and submit appeals with supporting documentation:
- Medical records
- Physician notes
- Authorization details
- Coding validation
- Draft strong appeal letters citing payer policy and CMS guidelines.
- Identify patterns (e.g., recurring medical necessity denials).
- Coordinate with Coding, CDI, Case Management, and Patient Access to prevent future denials.
- Recommend process improvements.
- Handle complex and high-value denied claims.
- Track appeal turnaround times and payer response deadlines.
- Generate denial trend reports.
- Present findings to leadership with corrective action plans.
- Ensure appeals meet payer-specific requirements.
- Maintain documentation for audit readiness.
How to Apply
Interested candidates can send your portfolio with updated CV and a brief cover letter to [email protected] with the subject line “Denial Management Specialist (Denial Expert)”.
About SolvEdge
Solvedge: Pioneering the Future of Digital Healthcare
Our Expertise
SOLVEDGE stands at the forefront of digital healthcare innovation as a premier healthcare performance company. With over 18 years of dedicated service in the healthcare industry, we specialize in a digital care journey platform that revolutionizes how hospitals and health systems engage, monitor, and connect with patients throughout their healthcare experiences. Our partnership with Fortune 100 medical device companies and hospitals nationwide underscores our position as a trusted partner in healthcare solutions.
Key Features of SOLVEDGE
Our platform is designed to empower healthcare providers with the tools they need to automate and streamline care delivery, thereby improving clinical outcomes and patient satisfaction:
- Personalized Care Plans: Leveraging evidence-based data, SOLVEDGE delivers digital care plans customized to meet the individual needs and conditions of each patient.
- Real-Time Patient Monitoring: Through daily health checks, assessment, surveys, and integration with wearable devices, our platform facilitates continuous monitoring of patient health.
- Automated Care Delivery: We automate essential tasks, including appointment scheduling, sending reminders, and delivering educational content, to enhance patient engagement and reduce administrative tasks.
- Remote Patient Monitoring: Healthcare providers can monitor vital signs, symptoms, and treatment plan adherence remotely, enabling timely interventions and proactive care management.
The SOLVEDGE Advantage
Our platform offers significant benefits to healthcare providers and patients alike:
- Improved Clinical Outcomes: By facilitating more effective care pathways and enabling early intervention, SOLVEDGE contributes to reduced readmission rates, fewer emergency department visits, and shorter hospital stays.
- Enhanced Patient Satisfaction: Patients enjoy a higher quality of care with SOLVEDGE, benefiting from improved communication, comprehensive education, and continuous support.
- Cost Savings: Healthcare organizations can achieve substantial cost reductions by minimizing unnecessary readmission, emergency visits, and complications associated with poor care management.
Applications and Impact: SOLVEDGE’s versatility allows for its application across various aspects of healthcare, with a particular emphasis on surgical care. From preparing patients for surgery to monitoring their post-operative recovery, our platform ensures a seamless and supportive care journey. Beyond surgical care, our focus encompasses managing care pathways, enhancing patient engagement through patient-reported outcomes, providing advanced data analytic, integrating with electronic medical records (EMR), and streamlining billing processes. Our comprehensive approach addresses the myriad challenges faced by today’s healthcare industry, backed by our commitment to excellence in service, communication, and customer experience.
A Trusted Partner in Healthcare Innovation: Our strategic relationships and deep understanding of healthcare challenges have positioned us as an indispensable ally to healthcare providers nationwide. As we continue to develop innovative solutions, our goal remains unchanged: to simplify healthcare delivery, improve patient outcomes, and enhance the overall patient experience.
