Denials/Appeals Analyst SRCO

Advocate Health•Oak Brook, IL

1d•$27 - $40•Remote

About The Position

The Denials/Appeals Analyst researches and analyzes denied claims to determine whether appeals are appropriate and to ensure compliance with payer and government rules and regulations. The role obtains medical documentation, reviews accounts, and writes technical appeal letters based on medical necessity. It also prepares claims for clinical appeal processing when denials involve authorization or medical necessity, and uses provider billing manuals to identify billing guidelines and requirements. The analyst prioritizes appeals based on payer filing limits, documents denial status in denial software, maintains a caseload, and monitors compliance with appeal decision time frames. The position collaborates with staff, identifies payer trends and issues, communicates findings to leadership, and meets monthly with the Denial Prevention Advisor to review denial trends and provide feedback on revenue-improvement opportunities. This is a full-time, 40-hour-per-week, totally remote position. The posted pay range is $26.55–$39.85.

Requirements

Bachelor's degree in Finance or a related field, or equivalent knowledge.
Typically requires 3 years of experience in hospital billing, finance, medical necessity denials management, coding, or a related field.
Experience with current CPT and HCPCS coding nomenclature and rules, ICD-9/ICD-10 coding conventions, and clinical documentation standards.
Previous clinical documentation and chart review experience, along with understanding of medical terminology.
Knowledge of appeal criteria and federal, state, and local regulations.
Excellent critical-thinking and analytical skills, with strong attention to detail.
Ability to meet deadlines in a fast-paced environment.
Ability to take initiative and work collaboratively with others.
Strong computer skills, including high proficiency with Microsoft Office Suite.
Desire to enhance knowledge, skills, and abilities.
Excellent writing skills to facilitate the advanced appeal process.

Responsibilities

Research and analyze denied claims for compliance with payer and government rules and determine whether an appeal is appropriate.
Obtain medical documentation required or requested by insurance carriers to support appeals.
Review and analyze accounts and write technical appeal letters based on medical necessity.
Collaborate with staff on denial-related issues.
Prepare claims for clinical appeal processing for authorization and medical necessity denials.
Use provider billing manuals to obtain billing guidelines and requirements and share information as needed.
Prioritize appeals according to filing limits established by individual payer contracts.
Document denial status on an ongoing basis in denial software.
Identify and analyze payer trends and issues and communicate findings to leadership.
Meet monthly with the Denial Prevention Advisor to review denial-category trends and provide feedback on opportunities to increase revenue.
Maintain a caseload and monitor day-to-day compliance with appeal decision time frames.