Denials Management Analyst

Prime Healthcare•Lewiston, ME

18h•Onsite

About The Position

The Denials Management Analyst identifies, analyzes, and resolves technical-based denials from insurance payers. The analyst works with revenue cycle staff and governmental and non-governmental insurance payers to determine denial sources and develop processes to eliminate or minimize denials and rejections, improving cash flow. The role also works denied and underpaid accounts to obtain full reimbursement for services through effective appeal writing and identifies denial and underpayment root causes. Central Maine Healthcare is an integrated healthcare delivery system serving approximately 400,000 residents across central, western, and midcoast Maine. Its network includes more than 40 primary and specialty care locations, Central Maine Medical Center in Lewiston, Bridgton Hospital, Rumford Hospital, and the Maine College of Health Professions.

Requirements

At least 1 year of experience billing or collecting for commercial insurance.
At least 2 years of experience billing or collecting for Medicare or Medicaid.
At least 1 year of experience within the denials management process.
Insurance knowledge, including basic coding, claims submission, collections, and prior authorization processes.
Familiarity with multiple insurance plans and their medical policies, professional and facility billing requirements.
Experience and understanding of working with billing reports and aged accounts.
Basic understanding of provider credentialing and third-party payer contracts.
Familiarity with CPT and ICD-9 manuals.
Familiarity with UB and HCFA 1500.
Ability to request and research information regarding billing procedures from Medicaid, commercial, and other third-party payers.

Responsibilities

Identify, analyze, and resolve technical-based denials from insurance payers.
Work with revenue cycle staff and governmental and non-governmental insurance payers to identify the source of denials.
Develop processes to eliminate or minimize denials and rejections and improve cash flow.
Work denied and underpaid accounts to obtain full reimbursement for services through effective appeal writing.
Identify denial and underpayment root causes.