Key Responsibilities

• Lead and perform denial claim audits to validate accuracy, documentation support, and resolution strategies.

• Perform Root Cause Analysis (RCA) on denial trends and direct appropriate cross-functional teams for resolution.

• Provide clear directives to the AR team on handling coding corrections, rebilling, resubmissions, and appeals.

• Conduct denial trend-based training and education sessions for coding teams and share provider metrics with Managers.

• Maintain accurate denial logs and recommend workflow controls like modifier validation prompts.

 

 

Please mention job code MEDTLDM