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.