Denials Analyst - Patient Financial Experience Days (M-F , 8a-5p) - 40hrs/wk

umhealthwest•Wyoming, MI

4d•Onsite

About The Position

Under limited direction, the Denials Analyst performs a wide range of duties involving the analysis of accounts denied by insurance carriers. Identifies issues resulting in the denial of claims. Performs ongoing analysis to determine the root cause of denials and makes well thought out recommendations for workflow, operations, or systematic changes. Takes corrective action to facilitate the re-billing and/or appeal of claims and subsequent reimbursement. Presents results in written visual and/or oral form to a variety of audiences including administration and clinical staff.

Requirements

Three (3) years of billing and/or denials management experience in hospital operations with a demonstrated understanding of revenue cycle with an emphasis on billing, coding, charge capture and reimbursement methodologies.
Bachelor’s Degree required.
Knowledge of medical terminology.
Basic knowledge of CPT’s, HCPCS, and Revenue Codes.
Basic knowledge of major insurance companies billing policies to ensure compliance.
Advanced knowledge of payor remittances.
Basic knowledge of insurance claim forms.
Demonstrates advanced skills MS Office to include Word and Excel.
Working knowledge of PowerPoint.
Experience analyzing billing data in Epic.
Strong analytical skills necessary to collect, analyze and interpret denials data, resolve complex problems.
Ability to organize, prioritize and manage multiple priority projects simultaneously.
Highly motivated, self-starter with attention to detail and accuracy with excellent written, verbal, and interpersonal skills.
Ability to work in a team environment as well as independently.
Knowledge of health system regulatory guidelines, standards and experience in healthcare setting strongly desirable.
Commitment to team support, participation, and excellence.
Ability to work with various levels of personnel, demonstrate tact and discretion when receiving and relaying information.

Nice To Haves

Knowledge of health system regulatory guidelines, standards and experience in healthcare setting strongly desirable.

Responsibilities

Identify denial trends and perform root cause analysis.
Categorizes denials based upon root cause findings and distributes reports to applicable management and teams.
Proactively work with multidisciplinary teams within the organization to develop procedures to reduce the number of denials received through reporting of denials and education of denial trends.
Assist with establishing and implementing denied claims process improvement initiatives and maintains the action plans to ensure plan objective are being obtained.
Research, develop and maintain a solid understanding of payer requirements, including filing limit, claim processing logic, coordination of benefits requirements, patient responsibility and authorization requirements.
Maintains a strong understanding of payer contracts and payment methodologies in order to identify their correlation to denied claims.
Conducts relevant research on best practice methods to assist with completing the appeals process while staying informed with policy reforms, new regulations, billing changes, and accreditation/compliance requirements.
Triages denied claims to identify those that should be appealed.
Responsible for writing timely, comprehensive and compelling appeals to third party payers to get denial overturned.
Responsible for timely follow up on filed appeals via telephone, writing or the payer website.
Compiles, maintains, and distributes reports on success of appeals and root cause analysis to management.
Serves as department resource related to denials and payer requirements.
Performs other duties as assigned. These may include but are not limited to: Maintaining a current knowledge base of department processes, protocols and procedures, pursuing self-directed learning and continuing education opportunities, and participating on committees, task forces, and work groups as determined by management.