In my previous role at a mid-sized healthcare provider, I was responsible for analyzing and resolving denied claims, which involved identifying trends, appealing unjust denials, and working closely with the billing and coding teams to prevent future denials. My efforts led to a 20% reduction in denials over six months by implementing targeted staff training and improving documentation practices.

I regularly attend webinars and workshops hosted by leading healthcare and insurance organizations, subscribe to industry newsletters, and participate in professional forums. This proactive approach ensures I'm always informed about the latest policy updates and denial codes, enabling me to effectively manage and reduce denials.

Once, I encountered a claim denied due to alleged lack of medical necessity. I gathered comprehensive clinical documentation, including physician notes and test results, and crafted a detailed appeal letter. By clearly demonstrating the necessity of the procedure, the denial was overturned, resulting in a $15,000 reimbursement for our facility.

I focus on preemptive measures such as thorough claim scrubbing before submission, regular staff training on coding and documentation best practices, and maintaining open communication with payers to understand their specific requirements. These strategies have significantly reduced our denial rates by ensuring claims are accurate and compliant from the outset.

I prioritize denials based on factors like the dollar amount, the likelihood of successful appeal, and the age of the claim. High-value claims with strong appeal prospects are addressed first, while systematic issues leading to frequent denials are flagged for process improvement. This method ensures efficient use of time and maximizes revenue recovery.