Team Lead - Resubmission & Reconciliation

Oversee the timely resubmission of denied claims, monitor payer behavior to mitigate financial risk, and enhance the quality of resubmissions to reduce denials. Collaborate closely with stakeholders—including physicians, insurance teams, and clinical documentation—to ensure compliance with industry regulations and achieve key performance indicators.

• Facilitate early closures of QMS related to resubmission and reconciliation • Engage physicians for clinical justification on rejected claims • Coordinate with insurance approvals and claims submission teams to minimize denials • Ensure resubmissions comply with industry and DHA regulations • Maintain and report resubmission KPIs • Analyze denial root causes and implement system rules to prevent recurrence • Educate billing and approval teams to improve process flow • Track payment discrepancies and report to HOD • Collaborate with business stakeholders to enhance overall resubmission efficiency • Analyze financial data to identify defaulting payors and recommend corrective strategies

• Certified professional coding certificate from a reputed institution • Certified medical/paramedical certificate • Minimum 4+ years’ experience in a leading resubmission role • Strong medical background for efficient reconciliation • Strong negotiation, analytical, and presentation skills • Leadership and supervisory capabilities • Conflict management, decision‑making, and operational thinking skills

• Certified professional coding certificate from a reputed institution • Certified medical/paramedical certificate • Minimum 4+ years of experience in a similar role