Denials Analyst

Requirements

• Required: Three (3) years of hospital/professional billing experience with an emphasis in denied claims follow-up, appeals processing, managed care and/or Medicare/Medi-Cal reimbursement methodologies
• Preferred: Patient accounting experience in a high-volume claims' environment
• Reports To: Manager-Denials Analytics
• Supervises: N/A
• Ages of Patients: N/A
• Blood Borne Pathogens: Minimal/ No Potential
• Skills, Knowledge, Abilities:
• Essential Responsibilities
• Demonstrates compliance with Code of Conduct and compliance policies, and takes action to resolve compliance questions or concerns and report suspected violations.
• Manages denial inventory on a timely basis to promote payment and resolution of all accounts as instructed by management.
• Stays current on all payer requirements by reading bulletins, reviewing provider handbooks, accessing websites, etc.
• Participates and engages in training sessions to grow knowledge base pertaining to denials, revenue cycle, and/or payor trends.
• Contacts payors, performs timely follow-up through direct phone calls, provider claims websites, correspondence, appeals, etc.
• Performs manual calculations of expected reimbursement to validate payor adherence to contracts.
• Performs in depth account research to understand every aspect of claims billing and resulting denial.
• Creates and submits strong succinct appeals that result in revenue recovery for all types of denials including contract underpayments, payor error denials, etc.
• Identifies patterns, trends, and root-cause for denials; reports findings to management to facilitate process improvement and resolution, including compilation of bulk denial issues across high volume of accounts.
• Generates and creates reports in Epic as requested.
• Adheres to HIPAA standards while performing denials research/resolution.
• Performs other duties as assigned.

Benefits

Additional Information

Default Work Shift: Day (United States of America) Hours: 40 Salary range: $21.75 - $33.04 Schedule: Full Time Shift Hours: 8 Hour employee Department: Denials Analytics Job Objective: Researches and resolves claim denials, ADR requests and certs; submits and tracks appeals, notes trends and provides monthly reports. Responds to audit requests (including RAC) from payors and maintains a Library of Payer reference material regarding requirement for pre authorization, medical necessity and documentation requirements. Works with the Revenue Cycle stakeholders (e.g. Admitting, Coding, Provider Liaisons, etc.) to provide information related to denials and opportunities for process improvement. Job Description: Education: Required: High school diploma, GED or higher level degree Preferred: Associate's degree Licensure/Certification: Preferred: Certified coder or currently enrolled in a coding program

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