Job Responsibilities:

• Provide end-to-end support for Professional Billing (PB) claims processing and analysis.
• Review, validate, and adjudicate professional/physician billing claims to ensure accuracy and compliance.
• Investigate and resolve complex claim issues, denials, and escalations related to PB claims.
• Analyze claim rejections and denial trends; recommend corrective actions to improve first-pass yield.
• Collaborate with internal teams (coding, billing, AR, and operations) to streamline workflows.
• Ensure compliance with payer guidelines, regulatory standards, and organizational policies.
• Maintain detailed documentation and support reporting/analytics for claim performance.
• Guide or mentor junior analysts on complex PB claims scenarios when required.

Must Have / Required:

• Strong experience in Professional Billing (PB) claims processing (physician/hospital outpatient billing).
• Hands-on experience with claim adjudication, denial management, and AR follow-ups.
• Deep understanding of CPT, ICD-10, modifiers, and payer-specific billing guidelines.
• Experience working in a senior/lead PB claims analyst role.
• Ability to independently handle complex claims and escalations.
• Familiarity with claims/billing systems and reporting tools.
• Strong analytical, problem-solving, and communication skills.

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