Denials Management & Reconciliation Analyst

Syr Comm Health Cntr•Syracuse, NY

1d•Hybrid

About The Position

The Denials Management & Reconciliation Analyst role involves processing of claims, posting electronic payments, claim adjustments, and review of non-coding related denials while working closely with patients, front desk staff and insurance carriers to ensure optimal submission and payment for all billable visits. This role requires expertise in healthcare billing, coding, electronic remittances and insurance policies to identify root causes of rejections, denials, appeal incorrect decisions, and implement strategies to minimize future denials. Works with software vendors and insurance companies to streamline and resolve issues identified throughout the claims process. Collaborates on performance improvement initiatives focused on coding, billing regulations, and coding standards such as ADA/CPT-4, HCPCS and ICD-10-CM. Coordinate with Medical Staff and coders for accurate charge capture and coding. Analyze clean claims rate, denials, days in AR, and recommend opportunities to the Director of Revenue Cycle. Investigates non-coding insurance denials and identifies and implements best-recommended action via feedback/reports to Director of Revenue Cycle Management. Understands and adheres to each insurance carrier’s claim submission guidelines. Makes necessary corrections to patient accounts for accurate electronic submission. Determines need for third party insurance payer appeal and sends individual appeal letters. Monitors appeals for resolution. Research, review and communicate with insurance carriers regarding open accounts receivable. Ensure compliance with company and regulatory standards. Prepare reports and presentations for quarterly departmental meetings. Assist with education and training for providers and front desk staff to ensure appropriate cash collection. Reports onsite for onboarding and orientation. Will consider hybrid schedule thereafter.

Requirements

Bachelor’s Degree in relevant field and 5-7 years of progressive, advancing, revenue cycle/medical billing experience or an equivalent combination of education, training, certification and progressive advanced experience in a healthcare setting, preferably in an Ambulatory Care, Outpatient facility operating in New York State.

Responsibilities

Processing claims
Posting electronic payments
Claim adjustments
Review of non-coding related denials
Work closely with patients, front desk staff and insurance carriers to ensure optimal submission and payment for all billable visits
Identify root causes of rejections, denials, appeal incorrect decisions, and implement strategies to minimize future denials
Work with software vendors and insurance companies to streamline and resolve issues identified throughout the claims process
Collaborate on performance improvement initiatives focused on coding, billing regulations, and coding standards such as ADA/CPT-4, HCPCS and ICD-10-CM
Coordinate with Medical Staff and coders for accurate charge capture and coding
Analyze clean claims rate, denials, days in AR, and recommend opportunities to the Director of Revenue Cycle
Investigate non-coding insurance denials and identifies and implements best-recommended action via feedback/reports to Director of Revenue Cycle Management
Understand and adhere to each insurance carrier’s claim submission guidelines
Make necessary corrections to patient accounts for accurate electronic submission
Determine need for third party insurance payer appeal and sends individual appeal letters
Monitor appeals for resolution
Research, review and communicate with insurance carriers regarding open accounts receivable
Ensure compliance with company and regulatory standards
Prepare reports and presentations for quarterly departmental meetings
Assist with education and training for providers and front desk staff to ensure appropriate cash collection