Denial Management Specialist

Job description

Cube Healthcare Systems is a subsidiary of the Healthcare Technology Company based in Michigan, USA providing healthcare solutions to the clients in the US. Presently, Cube Healthcare Systems is the largest company at KPIT board, with fast growing healthcare IT services and product base.

As a healthcare solution provider, CHS is successfully carrying out revenue management services for its clients based in the USA.

Our product: ALTUMED, a Revenue Cycle Management Software takes Medical Billing to another degree of automation and advancement. In Pakistan, with the main Office in Abbottabad, business teams are pro-actively making client experience and business a success.

Shift: Evening (5:30pm-2am)

Job Overview:

The Denial Management Specialist is responsible for overseeing and managing the denial resolution process for all claims related to cardiology services. This role requires a deep understanding of medical billing and coding, as well as expertise in navigating insurance regulations and payer guidelines specific to cardiology procedures.

Responsibilities:

1. Aanalyze denied claims to identify root causes and trends.

2. Develop and implement strategies to prevent future denials.

3. Review coding and documentation to ensure accuracy and compliance with payer requirements.

4. Collaborate with billing and coding staff to resolve denials and appeal denied claims.

5. Communicate effectively with insurance companies to negotiate and resolve denials.

6. Stay current with changes in healthcare regulations, payer policies, and coding guidelines related to cardiology services.

7. Generate reports and metrics to track denial trends and measure the effectiveness of denial management efforts.

8. Work closely with revenue cycle management team to optimize reimbursement and minimize revenue loss.

9. Maintain confidentiality of patient information and adhere to HIPAA regulations.

10. Ensuring timely reimbursement for cardiology services by effectively managing and resolving claim denials.

Requirements:

1. Minimum of three years of experience in medical billing and coding, with a focus on cardiology services.

2. In-depth knowledge of CPT, ICD-10, and HCPCS coding systems.

3. Familiarity with insurance claims processing and denial resolution procedures.

4. Strong analytical and problem-solving skills

5. Excellent communication and interpersonal abilities.

6. Ability to work independently and collaboratively in a fast-paced environment.

7. Proficiency in using medical billing software and Microsoft Office applications.

Required skills:

• Bachelor’s or Master’s Degree in science preferably D- Pharm, Physiology Biochemistry, BBA, MBA etc.
• Candidates with 3 years plus of experience in the medical billing Industry.
• Excellent domain knowledge of the US- Healthcare Industry.
• Ability to read, analyse and interpret complex documents.
• Extensive knowledge of the use of email, search engine, Internet; ability to effectively use payer websites.
• Proficient with Microsoft products (Excel, Word, Outlook).
• Ability to work under pressure and complete the project by meeting the deadlines.
• Excellent interpersonal communication skills and should be a good team player.
• Must be detail-oriented, highly organized, and results-driven.

Benefits:

Market-Leading Salary, Medical insurance, Provident fund, EOBI, Paid Leaves, cash advance, Employee Performance based bonuses, Annual increments, Allowances ( Accommodation, OPD, Travel, Night, utilities, Technical ), Parental Leaves, Annual dinners & trips

Note: Preference will be given to candidates from Hazara Division, KPK for this specific role. However, candidates from all over the Pakistan are welcomed.

For more information, please visit:

www.cubehcs.com

Job Type: Full-time