Denial Management Specialist

Before you apply: Candidates must live in Lahore or Islamabad

Position Overview

As a Denial Management Specialist , you will be responsible for denial prevention, claim review, coding accuracy, and appeal processing. You will investigate denied claims, identify coding and documentation issues, correct and resubmit claims, and work with providers, insurance representatives, and internal billing teams to support timely reimbursement.

The role also involves monitoring payer and regulatory updates, identifying denial trends, and supporting provider and staff education when needed.

Employment Type: Remote

Work Schedule: Monday–Friday | Schedule based on client requirements- Schedule can be in PST/MST/EST/CST)

Key Responsibilities

• Follow up on denied claims from commercial and contracted payers, particularly denials related to coding errors.
• Assign and sequence ICD-10-CM and CPT-4 codes and review physician documentation for coding accuracy.
• Correct coding issues in accordance with Medicare and AMA coding guidelines .
• Review and analyze medical records to ensure accurate ICD and CPT code selection.
• Serve as a coding subject matter expert within the denial management function.
• Thoroughly investigate denied claims and determine the appropriate course of action for resubmission.
• Coordinate with providers, insurance representatives, collection specialists, and charge posters to resolve claim issues.
• Validate and follow up on denied claims, including initial assessment of denials received through EDI.
• Identify coding trends contributing to increased denial volumes and escalate them to management.
• Resolve routine coding issues and identify opportunities for additional staff and provider training.
• Stay informed about changes in payer requirements and applicable state and federal regulations.
• Support assigned special projects, including provider and staff training and education.
• Maintain strict HIPAA compliance and confidentiality of patient information.
• Participate in QA/QI activities and organizational performance improvement initiatives.
• Learn and use Electronic Health Record and Practice Management systems as required.

Tools & Systems

• 3M Encoder and/or Encoder Pro
• Microsoft Excel
• Microsoft Office
• Electronic Health Record (EHR) systems
• Practice Management systems
• EDI/claims processing systems

Qualifications

• High School Diploma or GED required.
• CPC, CPCH, and/or CCS-P certification required.
• Minimum 2 years of billing and accounts receivable experience in a physician practice.
• 2 years of experience in an FQHC environment.
• Minimum 3 years of physician coding experience in a multi-specialty environment.
• Strong working knowledge of ICD-10-CM and CPT-4 coding .
• Knowledge of coding rules and third-party payer requirements.
• Ability to maintain annual coding certification requirements.
• Strong analytical skills within a medical billing environment.
• Proficient in Excel and Microsoft Office products.
• Strong communication skills when working with providers and management.
• Ability to work effectively under pressure.
• Strong understanding of denial management and claim follow-up processes.

Compliance & Quality

• Maintain compliance with HIPAA regulations and requirements .
• Protect confidential member and patient information.
• Ensure compliance with applicable local, state, and federal regulations.
• Participate in Quality Assurance / Quality Improvement (QA/QI) activities.
• Support organizational performance improvement initiatives.

Our Hiring Process

1. Application Review: Create your profile at https://talent.onedge.co/ Our team carefully reviews applications to identify the best fit.
2. Skills Assessment: Shortlisted candidates may complete an assessment to evaluate relevant technical and communication skills.
3. Client Interviews: Qualified candidates will participate in interviews with our healthcare clients.
4. Final Selection: Successful candidates will join the Edge Global Talent Network and be matched with opportunities across North America.

Why Join Edge?

• Work with leading North American healthcare organizations.
• Be part of a growing global healthcare talent community.
• Build an international career without relocating.
• Gain exposure to U.S. healthcare billing, coding, and revenue cycle operations.
• Access long-term career growth and professional development opportunities.

Talent Boilerplate:

At Edge, we’re on a mission to create a world where geographic borders are no longer a barrier for people to obtain full-time employment and fair wages. That’s why we’ve created a global hiring network that seamlessly connects exceptional talent from all over the world with businesses in North America that most need to fill positions. The Edge Talent Network is a community of like-minded professionals through which you can unlock your potential, showcase your skills, and earn what you’re worth.

Equal Opportunity Employer Statement:

Edge is proud to be an equal-opportunity employer. We are committed to fostering a diverse and inclusive work environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, physical or mental disability, age, veteran status, or any other legally protected basis.

PS: Dont wait, start building your profile on https://talent.onedge.co!!!