Charge Entry - Rejections

Job Title: Medical Billing Rejections Specialist

Years of Experience: 5-7 years

Shift Timings: day shift (9:00 AM to 6:00 PM)

Location: Hyderabad, Telangana

Job Summary:
We are looking for an experienced Medical Billing Rejections Specialist to review, analyze, and resolve claim rejections and billing issues. The candidate should have strong knowledge of medical billing processes, payer requirements, claim submission, and rejection management. The role requires identifying the root cause of rejections, making necessary corrections, and resubmitting claims within timely filing limits.

Key Responsibilities

• Review and analyze medical claim rejections from insurance payors.
• Identify the root cause of claim rejections and determine the appropriate corrective action.
• Correct and resubmit rejected claims within payer-specific timelines.
• Work on common rejection issues related to CPT/HCPCS codes, ICD-10 codes, modifiers, NPI, eligibility, authorization, bundling, and payer edits.
• Verify patient demographics, insurance information, and claim details.
• Follow up with payors when additional information or clarification is required.
• Maintain accurate documentation of rejection reasons and actions taken.
• Monitor rejection trends and identify recurring issues.
• Coordinate with coding, charge entry, eligibility, and other teams to resolve claim issues.
• Meet daily productivity, quality, and turnaround-time targets.
• Ensure compliance with payer guidelines and company policies.

Required Qualifications

• 5+ years of experience in US healthcare/medical billing, preferably in claim rejections or A/R.
• Strong knowledge of US medical billing and insurance processes.
• Experience working with Medicare, Medicaid, and commercial payors.
• Good understanding of CPT, HCPCS, ICD-10, and modifiers.
• Experience with claim clearinghouses and billing systems.
• Strong analytical and problem-solving skills.
• Good written and verbal communication skills.
• Ability to work independently and manage high-volume claim workloads.

Preferred Skills

• Experience handling EDI/clearinghouse rejections.
• Knowledge of NCCI edits, LCD/NCD guidelines, medical necessity, and payer-specific billing rules.
• Experience identifying trends and preventing recurring claim rejections.
• Familiarity with Epic, NextGen, AMD, eClinicalWorks, or other medical billing platforms is a plus.

Key Performance Indicators (KPIs)

• Daily rejection volume and productivity
• Rejection resolution rate
• First-pass resolution rate
• Claim resubmission turnaround time
• Quality/accuracy
• Timely filing compliance
• Reduction in recurring rejections

Contact Info:

Shivani: [phone removed]