Denials Management Analyst

Nebraska Methodist Hospital•Omaha, NE

2d•Hybrid

About The Position

The Denials Management Analyst is responsible for reviewing denials for commercial/government payers, physician/facility claims, and escalating appeals to payers as needed to obtain maximum reimbursement in compliance with payer contracts and CMS regulations. This role offers the flexibility to work from home after successfully completing training and meeting quality and production goals. Nebraska Methodist Health System emphasizes a culture of exceptional care, known as 'The Meaning of Care,' where employees are valued and contribute to making a real difference in the communities they serve.

Requirements

High School Diploma or General Educational Development (G.E.D.) required.
Minimum 1-2 years experience working for a 3rd party payer or health care provider required.
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.
Exerting up to 20 pounds of force (Light Work).

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 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.
Demonstrate 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 answer inquiries from internal and external sources.
Handle denials correctly and resolve denials in RCA according to department policy.
Perform 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 escalate payer issues.
Assist with tracking payer agenda issues.
Provide training on contracts and reimbursement to other areas as needed.