Denials Management Analyst

Best Care • Omaha, NE

9d • Onsite

About The Position

Why work for Nebraska Methodist Health System? At Nebraska Methodist Health System, we focus on providing exceptional care to the communities we serve and people we employ. We call it The Meaning of Care – a culture that has and will continue to set us apart. It’s helping families grow by making each delivery special, conveying a difficult diagnosis with a compassionate touch, going above and beyond for a patient’s needs, or giving a high five when a patient beats a disease or conquers a personal health challenge. We offer competitive pay, excellent benefits and a great work environment where all employees are valued! Most importantly, our employees are part of a team that makes a real difference in the communities we live and work in. Job Summary: Location: Methodist Corporate Office Address: 825 S 169th St. - Omaha, NE Work Schedule: Mon - Fri, business hours Responsible for review of denials for commercial / government, physician / facility and escalation of appeals to the payers as needed to obtain the maximum reimbursement in compliance to payer contracts and CMS regulations.

Requirements

• High School Diploma or General Educational Development (G.E.D.) required. College coursework in accounting and or health care preferred.
• Minimum 1-2 years experience working for a 3rd party payer or health care provider required.
• Minimum 1 year of insurance billing experience preferred.
• Six months Institutional and Professional ICD and CPT coding preferred.
• Six months experience with DRG reimbursement and outpatient including ASC grouper, ER and outpatient reimbursement preferred.
• Experience in researching Institutional and Professional claims to determine correct contract reimbursement using payer contracts preferred.
• Skill using Microsoft Office, including Word, Excel, and Outlook.
• Skill performing 10 key data entry.
• Skill with verbal and written communication.
• Knowledge of medical terminology.
• Knowledge of patient accounting software and payer websites.
• Knowledge of Universal Billing (UB) and Healthcare Financing Administration (HCFA) billing formats.
• Knowledge of International Classification of Disease (ICD), Current Procedural Terminology (CPT), Revenue Codes, understanding of DRG methodology.
• Knowledge of facility contracting rates.
• Knowledge of CMS (Center for Medicare and Medicaid Services).
• Knowledge of WPS ANSI remark codes.
• Ability to maintain confidentiality.
• Ability to read and understand payer explanation of benefits (EOB).
• Ability to use basic accounting and math principles.
• Ability to identify, trend and analyze data.
• Ability to learn new software programs.
• Ability to organize and prioritize work.
• Ability to work independently.
• Ability to identify and trend issues to improve or streamline processes.
• Ability to maintain a professional demeanor with internal and external contacts.

Nice To Haves

• College coursework in accounting and or health care preferred.
• Minimum 1 year of insurance billing experience preferred.
• Six months Institutional and Professional ICD and CPT coding preferred.
• Six months experience with DRG reimbursement and outpatient including ASC grouper, ER and outpatient reimbursement preferred.
• Experience in researching Institutional and Professional claims to determine correct contract reimbursement using payer contracts preferred.

Responsibilities

• Analyze denials compared to the applicable contract agreements, payer medical policy language, NMHS coding and authorization processes. Analyze payments to ensure accuracy and initiate corrective action with third party payers. Demonstrates understanding of contract and reimbursement language. Maintain a follow up and reporting system to ensure receipt of reimbursement.
• Analyze and research contractual and reimbursement issues and answers inquiries from internal and external sources. Correct handling of denial. Resolve denial in RCA according to department policy. Timely follow-up of denials, appeals, etc.
• Assist staff with work volume as needed. Respond to special requests with accurate information. Provide contract/payor recommendations.
• Participate in payer meetings and escalates payer issues. Assist with tracking payer agenda issues.
• Provide training on contracts and reimbursement to other areas as needed.

What This Job Offers

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