DENIALS ANALYST I
Riverside Healthcare•Kankakee, IL
•Onsite
About The Position
The Denials Analyst I is responsible for analyzing, managing, and resolving denied claims at Riverside Healthcare. This role involves reviewing denied claims related to small level medical necessity denials to identify root causes and appeal said denials. The Denials Analyst works closely with billing, coding, and revenue cycle teams to ensure accurate and timely claim resolution.
Requirements
- 0-2 years of experience in claims management, denial analysis, or revenue cycle operations within a healthcare setting.
- Basic knowledge of payer policies, medical coding (ICD-10, CPT, HCPCs), and healthcare reimbursement processes.
- Strong communication skills, both written and verbal, with the ability to interact effectively with insurance companies and internal teams.
- Ability to work under supervision, prioritize tasks, and manage time effectively.
- Speech: Needed for presentations/training, telephone communication, facilitate meetings.
- Vision: Needed to read memos and literature.
- Hearing: Needed for telephone communications, meetings, and listening to employee concerns.
- Touch: Need to write, do computer entry, filing.
- Sit: 85%
- Stand: 5%
- Walk: 5%
- Lift: 2%
- Squat: 1%
- Bend: 1%
- Reach above shoulders: 1%
- Up to 10 lbs: Occasionally
- Up to 20 lbs: Occasionally
- Simple grasp up to 10 lbs.
- Normal weight: 5- 10lbs frequent
- Pushing & pulling Normal weight
- Fine Manipulation: Terminal entry, calculator.
- Inside hours: 40
- Temperature: Normal Range
- Lighting: Average
- Noise levels: Average
- Humidity: Normal Range
- Atmosphere: Dust &Poor Ventilation
Nice To Haves
- Associates degree in Healthcare Administration, Business, Finance, or a related field preferred.
- Continuously update knowledge on industry standards and best practices.
Responsibilities
- Review and analyze denied claims to determine the reason for denial and potential for resolution.
- Collaborate with billing and coding teams to gather necessary documentation and information for appeals.
- Monitor and track the status of denied claims and appeals, ensuring timely follow-up and resolution.
- Assist in maintaining detailed records of denial trends, appeal outcomes, and related activities for reporting and analysis.
- Stay informed about basic changes in payer policies, coding guidelines, and industry regulations that may impact claim denials and resolution.
- Work small level medical necessity denials specific to laboratory and radiology.
- Proficiently pull and send in medical records for payer audit requests.
- Develop and submit appeal letters to insurance companies, utilizing accurate data and thorough explanations to support claim adjustments.
Benefits
- Comprehensive suite of Total Rewards
- Nationally rated employee well-being programs
- Competitive compensation
- Generous retirement offerings
- Programs that invest in your career development
- Paid Time Off programs
- Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
- Health Savings and Flexible Spending Accounts for eligible health care and dependent care expenses
- Defined contribution retirement plans with employer match and other financial wellness programs
- Educational Assistance Program
- Paid Leave Hours accrued as you work
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
Associate degree
