SME – Denial Management

🚨 We’re Hiring! 🚨

SME – Denial Management | Experience: 2-3 Years

📍 Location: Infopark Koratty

Zapare Technologies Pvt. Ltd. – a leading provider of Revenue Cycle Management (RCM) solutions for the US Healthcare industry, is looking for dynamic and ambitious professionals to join our growing team.

About the Role:

As an SME – Denial Management, you will play a key role in analyzing, managing, and resolving denied insurance claims. Your expertise will directly contribute to improving collections and optimizing the revenue cycle for our clients.

Key Responsibilities:

✅ Review and analyze denied claims to identify root causes such as coding errors, preauthorization gaps, or payer-specific policies.

✅ Develop and maintain denial logs to monitor trends and patterns.

✅ Communicate with payers to clarify denials and initiate timely appeals.

✅ Work with denial reason codes (CARC, RARC) to determine appropriate actions.

✅ Ensure compliance with HIPAA, CMS guidelines, and coding standards (CPT, ICD-10, HCPCS).

Appeals Process Management:

Understand 1st, 2nd, 3rd, and External Level Appeal processes and SOPs.

Prepare, submit, and follow up on appeals with complete and accurate documentation.

Review EOBs, case histories, and payer policies to strategize appeals.

Gather necessary patient/physician consents and medical records.

Draft effective appeal letters and complete special forms required by payers or states.

Maintain records of appeals, responses, and recovery outcomes.

Monitor deadlines and ensure timely submissions.

Stay updated on payer policies, state requirements, and denial trends.

Desired Skills & Experience:

✔ Strong understanding of the US healthcare billing cycle.

✔ Hands-on experience with EMR/EHR systems like Epic, Cerner, Allscripts, Athenahealth, NextGen, eClinicalWorks, Meditech, etc.

✔ Expertise in denial analysis, appeal filing, and payer interactions.

✔ In-depth knowledge of billing regulations, coding standards, and compliance frameworks.

If you have a passion for healthcare revenue management and a keen eye for resolving complex denials, we’d love to hear from you!

👉 Apply Now & Join the Zapare Team!

#Hiring #DenialManagement #RCM #HealthcareJobs #MedicalBilling #RevenueCycleManagement #ZapareTechnologies #CareerOpportunity