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Denials Rules Associate
A company is looking for a Denials Rules Associate to enhance the accuracy and impact of Denials Rules across various service lines. Key Responsibilities Create mappings based on payer, CARC/RARC codes, and CPT codes to support workflow decisions and process automation Review data sets for inconsistencies and collaborate with internal teams to manage data effectively Work with project teams to develop workflows and validate data mappings while identifying opportunities for process optimization Required Qualifications Intermediate+ level experience with SQL programming Experience with ETL processes in a SQL environment Familiarity with 837/835 transaction sets and CARC/RARC codes Understanding of ICD-10, HCPCS/CPT coding, and medical terminology Proficiency in Microsoft Office, especially Excel
A company is looking for a Denials Rules Associate to enhance the accuracy and impact of Denials Rules across various service lines.
Key Responsibilities
Create mappings based on payer, CARC/RARC codes, and CPT codes to support workflow decisions and process automation
Review data sets for inconsistencies and collaborate with internal teams to manage data effectively
Work with project teams to develop workflows and validate data mappings while identifying opportunities for process optimization
Required Qualifications
Intermediate+ level experience with SQL programming
Experience with ETL processes in a SQL environment
Familiarity with 837/835 transaction sets and CARC/RARC codes
Understanding of ICD-10, HCPCS/CPT coding, and medical terminology
Proficiency in Microsoft Office, especially Excel