Denials/Appeals Analyst

Singing River Health System • Gautier, MS

11d • Remote

About The Position

The Denials and Appeals Analyst assists in the recovery of Health System revenue by managing the life cycle of denied claims. They work collaboratively with departmental peers throughout the System to achieve departmental and system-wide quality, satisfaction, and financial goals. The Denials and Appeals Analyst coordinates the appeals process for denials deemed appropriate by the Patient Financial Services Director and the Denials Manager. They assure prompt action is taken on assigned denials by coordinating with clinical staff to create written and/or verbal clinical appeals with payers. The Analyst works closely with third party payors, Managed Care representatives, insurance billing staff, case management, and other service departments to resolve denied claims. They are a liaison which communicates claim denials related status and updated information to Organizational Leaders. Expectation is for all performed duties to be in accordance with Singing River Health System procedures and policies, accreditation organization, and governing guidance and publications for health care employees.

Requirements

• High School Diploma or equivalent required.
• A minimum of three (3) years’ patient accounting and insurance experience required.
• Must have de-escalation training completed by the end of position orientation (90 days).
• Must demonstrate keen mental faculties/assessment and decision making abilities.
• Must demonstrate superior communication/speaking/enunciation skills to receive and give information in person and by telephone.
• Must demonstrate strong written and verbal communication skills.
• Must possess emotional stability conducive to dealing with high stress levels.
• Must demonstrate ability to work under pressure and meet deadlines.
• Attention to detail and the ability to multi-task in complex situations is required.
• Must have the ability to maintain collaborative and respectable working relationships throughout SRHS and other organizations.
• Must possess superior customer service skills and professional etiquette.
• Must possess proficient knowledge and ability to use a computer (must be keyboard proficient) and other office technology (i.e., telephone, fax, etc.), MS Outlook and Word.

Nice To Haves

• Associate’s degree preferred.
• Epic certification in Resolute Hospital Billing and/or Certified Coding Specialist preferred.
• Experience in a hospital and/or physician office preferred.

Responsibilities

• Manages the life cycle of denied claims.
• Coordinates the appeals process for denials.
• Assures prompt action is taken on assigned denials by coordinating with clinical staff to create written and/or verbal clinical appeals with payers.
• Works closely with third party payors, Managed Care representatives, insurance billing staff, case management, and other service departments to resolve denied claims.
• Communicates claim denials related status and updated information to Organizational Leaders.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED