Denials/Appeals Analyst

Singing River Health System • Gautier, MS

21h

About The Position

Position Overview: 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. DISCLAIMER: This is not necessarily an exhaustive list of all responsibilities, duties, skills, efforts, requirements or working conditions associated with the job. While this intends to be an accurate reflection of the current job, management reserves the right to revise the job or to require that other or different tasks performed as assigned.

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 have appropriate level of de-escalation training.
• 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.
• Job may require traveling throughout the SRHS service area - with the employee providing their own transportation.
• Travel for education purposes may be required.

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

• Assists in the recovery of Health System revenue by managing the life cycle of denied claims.
• Works collaboratively with departmental peers throughout the System to achieve departmental and system-wide quality, satisfaction, and financial goals.
• Coordinates the appeals process for denials deemed appropriate by the Patient Financial Services Director and the Denials Manager.
• 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.
• Acts as a liaison which communicates claim denials related status and updated information to Organizational Leaders.
• Performs duties in accordance with Singing River Health System procedures and policies, accreditation organization, and governing guidance and publications for health care employees.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED
• Number of Employees: 501-1,000 employees