Commure is looking for Operations Analyst, Secondary Submission 2025 in Dhaka
Job Responsibilities:
- Analyze and resolve denied medical claims, focusing on CARC/RARC codes and payer-specific denial reasons.
- Collaborate with coding, billing, and enrollment teams to identify and prevent recurring denial patterns.
- Review and interpret Explanation of Benefits (EOBs), Electronic Remittance Advice (ERAs), and LCD/NCD coverage guidelines.
- Work on denials related to modifiers, timely filing, COB, ICD/CPT mismatches, and medical necessity.
- Track resolution timelines, maintain denial logs, and contribute to denial dashboards and performance metrics.
- Assist in preparing appeals and resubmissions, ensuring accurate and compliant documentation.
- Maintain updated knowledge of CMS, Medicare, Medicaid, and commercial payer requirements.
- Contribute to internal denial runbooks, SOPs, and reference documentation.
Location:
BangladeshBenefits
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Eligibilities
Job Requirements:
Education
- Bachelor’s degree in Healthcare Administration, Business, Life Sciences, or a related field.
- Additional training or certifications in Medical Billing, CPC, or RCM fundamentals are a plus.
Professional Experience
- Hands-on experience with denial codes (CO, PR), modifiers, ICD-10/CPT coding, and CLIA compliance.
- Familiarity with EHR systems and clearinghouse platforms.
- Understanding of LCD/NCD policies and payer-specific coverage guidelines.
Technical and Analytical Skills
- Strong analytical abilities to investigate and resolve claim denial root causes.
- Ability to interpret and work with large volumes of claims data, remittance files, and denial reason codes.
- Comfortable using Microsoft Excel, Google Sheets, and reporting tools.
- Experience with Notion or similar documentation tools is a plus.
Soft Skills
- Excellent written and verbal communication skills to interact with cross-functional teams and explain complex denial cases.
- Detail-oriented with a proactive problem-solving approach.
- Capable of working both independently and collaboratively in a high-volume, performance-driven environment.
- High adaptability and eagerness to stay updated with payer policies and regulatory changes.
Preferred Skills
- Exposure to Medicare, Medicaid, and commercial payer workflows.
- Experience in appeal writing and supporting payer audits.
- Familiarity with maintaining or contributing to a denial runbook or appeals log
For Further Queries
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