Job Description

Key Responsibilities: Team Management Leadership: Supervise and mentor a team of rejection specialists, ensuring productivity and quality targets are met. Provide training on rejection trends, payer guidelines, and best practices for rejection resolution. Monitor team performance, conduct regular reviews, and implement process improvements. Collaborate with other RCM teams (Billing, AR, Denials) to optimize claim processing efficiency. Rejection Analysis Resolution: Oversee daily rejection reports and ensure rejections are addressed promptly to prevent claim denials. Identify recurring rejection patterns and work with the team to implement corrective actions. Guide the team in understanding payer-specific requirements and making necessary claim corrections. Escalate unresolved rejections to the appropriate team or payer for further resolution. Process Improvement Compliance: Analyze rejection trends and provide recommendations to improve clean claim submission rates. Develop and maintain standard operating procedures (SOPs) for handling different types of rejections. Ensure compliance with HIPAA regulations and payer policies. Work closely with billing, coding, and credentialing teams to minimize avoidable rejections. Reporting Communication: Prepare and present rejection analysis reports, including root cause analysis and resolution strategies. Communicate effectively with payers, providers, and internal stakeholders to resolve issues. Maintain accurate documentation of rejection trends, team performance, and corrective actions taken. Qualifications Requirements: Education: Bachelors degree preferred (Healthcare Administration, Business, or related field) or equivalent experience. Experience: Minimum 3-5 years of experience in RCM medical billing, with at least 1-2 years in a supervisory role . Industry Knowledge: Strong understanding of behavioral health billing , insurance guidelines, and payer policies. Technical Skills: Proficiency in EHR systems (e.g., Insync, Credible) and claim management software. Analytical Skills: Ability to analyze rejection trends, identify root causes, and implement process improvements. Communication Skills: Excellent verbal and written communication for team coordination and payer interactions. Problem-Solving: Strong problem-solving skills to resolve complex claim rejections efficiently. Preferred Qualifications: Experience with automated rejection management tools . Familiarity with EDI transactions (837, 835, 270, 271, 277, 999, etc.) . Knowledge of denial management and coordination with AR teams.