Insurance Reviewer and Denials Analyst - Patient Financial Services - FT Days

ANDERSON HOSPITAL•Maryville, IL

5d•$16 - $25•Onsite

About The Position

The Insurance Reviewer and Denials Analyst is responsible for reviewing and analyzing unpaid aging non-government claims to determine the necessary actions for resolution. This role also involves reviewing, analyzing, and appealing insurance payor denials, as well as processing insurance payor refund requests related to retroactive claim denials. The duties encompass accounts for Anderson Hospital, Community Hospital of Staunton, Maryville Imaging, and Anderson Home Health.

Requirements

High school diploma or equivalent.
5 years experience in hospital insurance follow-up and/or denials processing preferred.
5 years experience in hospital patient accounts experience preferred.
5 years experience in insurance follow-up and knowledge preferred.
Office procedures and keyboarding minimum 50 wpm preferred.
Microsoft Word and Excel experience preferred.
Other computer and organizational skills preferred.
Meditech experience helpful.

Responsibilities

Reviews and analyzes unpaid aging non-government claims daily utilizing Meditech automated Tasks.
Determines current account status.
Follows up on payor websites or with payor customer service departments to determine payor status of claim adjudication.
Provides necessary action steps to expedite claim payment by payor.
Analyzes payor remittance advices to determine any needed action steps if partial payment is made by payor.
Determines if other insurance payors must be billed in the correct coordination of benefit order.
Escalates problem accounts to team or department leadership.
Notifies Director of Patient Access of Registration errors via Commercial Collections Supervisor.
Notifies Commercial Collections Supervisor of all other opportunities for improvement or reimbursement variance resolution.
Identifies Opportunities for Process Improvement in Patient Financial Services or Patient Access.
Reviews, analyzes, and takes appropriate actions on payor refund request letters related to denial issues.
Determines when to refund payors; authorize recoupments by payors; or appeal regarding disagreement with refund requests.
Reviews, analyzes, and takes appropriate actions regarding payor denials, utilizing Denials Management in Meditech.
Appeals denials whenever possible.
Reviews, analyzes, and takes appropriate actions with other insurance correspondence received.
Communicates regarding issues with Commercial Manager and PFS Director.
Performs other duties as assigned, particularly as potential back-up for the Insurance Reviewer team and for Customer Service as needed.