[Hiring] Denials Management Analyst @Best Care

Role Description

Responsible for review of denials for commercial / government, physician / facility and escalation of appeals to the payers as needed to obtain the maximum reimbursement in compliance to payer contracts and CMS regulations.

• Analyze denials compared to the applicable contract agreements, payer medical policy language, NMHS coding and authorization processes.
• Analyze payments to ensure accuracy and initiate corrective action with third party payers.
• Demonstrates understanding of contract and reimbursement language.
• Maintain a follow up and reporting system to ensure receipt of reimbursement.
• Analyze and research contractual and reimbursement issues and answer inquiries from internal and external sources.
• Correct handling of denial.
• Resolve denial in RCA according to department policy.
• Timely follow-up of denials, appeals, etc.
• Assist staff with work volume as needed.
• Respond to special requests with accurate information.
• Provide contract/payor recommendations.
• Participate in payer meetings and escalate payer issues.
• Assist with tracking payer agenda issues.
• Provide training on contracts and reimbursement to other areas as needed.

Qualifications

• High School Diploma or General Educational Development (G.E.D.) required.
• College coursework in accounting and or health care preferred.
• Minimum 1-2 years experience working for a 3rd party payer or health care provider required.
• Minimum 1 year of insurance billing experience preferred.
• Six months Institutional and Professional ICD and CPT coding preferred.
• Six months experience with DRG reimbursement and outpatient including ASC grouper, ER and outpatient reimbursement preferred.
• Experience in researching Institutional and Professional claims to determine correct contract reimbursement using payer contracts preferred.

Requirements

• Skill using Microsoft Office, including Word, Excel, and Outlook.
• Skill performing 10 key data entry.
• Skill with verbal and written communication.
• Knowledge of medical terminology.
• Knowledge of patient accounting software and payer websites.
• Knowledge of Universal Billing (UB) and Healthcare Financing Administration (HCFA) billing formats.
• Knowledge of International Classification of Disease (ICD), Current Procedural Terminology (CPT), Revenue Codes, understanding of DRG methodology.
• Knowledge of facility contracting rates.
• Knowledge of CMS (Center for Medicare and Medicaid Services).
• Knowledge of WPS ANSI remark codes.
• Ability to maintain confidentiality.
• Ability to read and understand payer explanation of benefits (EOB).
• Ability to use basic accounting and math principles.
• Ability to identify, trend and analyze data.
• Ability to learn new software programs.
• Ability to organize and prioritize work.
• Ability to work independently.
• Ability to identify and trend issues to improve or streamline processes.
• Ability to maintain a professional demeanor with internal and external contacts.

Benefits

• Competitive pay.
• Excellent benefits.
• Great work environment where all employees are valued.