Appeals Executive/ Sr. Executive

We are seeking a skilled Appeals Specialist to join our dynamic RCM team. This role is critical in analysing and reversing denials of claims by conducting thorough reviews, submitting well-documented appeals, and ensuring that all claims are compliant with applicable laws, regulations, and payer policies.

Responsibilities:

• Review and analyse claims denied by insurance companies to determine the grounds for denial.
• Prepare and submit appeal letters and supporting documentation to overturn denied claims based on sound medical and legal reasoning.
• Track the status of appealed claims and follow up with payers to ensure timely resolution.
• Maintain detailed records of all appeals, correspondence, and outcomes.
• Ensure compliance with all federal and state regulations as well as payer policies regarding billing and appeals processes.

Preferred candidate profile

• Bachelors degree in Health Administration, Finance, Legal Studies, or related field.
• Minimum of 2 years experience in medical billing and coding, with a strong emphasis on denials and appeals.
• In-depth knowledge of medical terminology, ICD-10, CPT codes, and billing regulations.
• Proven track record of successfully appealing denied claims and recovering funds.
• Excellent analytical, organisational, and communication skills.
• Proficiency in medical billing software and electronic health records (EHR) systems.