Sr. Denials Management Analyst

Best Care•Omaha, NE

1d•Onsite

About The Position

The Sr. Denials Management Analyst provides escalated support for facility and physician payer reimbursement matters involving denials, refunds, and other contractual payment issues. The role serves as a resource for resolving payer claim payment and denial issues, reconciles explanation of benefits and payments against fee schedules, and works with payers or patients to obtain contractual payments when discrepancies are found. The position also maintains knowledge of payer-specific regulatory issues, insurance updates, and departmental functions; supports employee orientation and training; communicates issues to management; and contributes to process improvement, documentation, and system testing. The role is based at the Methodist Corporate Office, 825 S 169th St., Omaha, Nebraska. The schedule is Monday through Friday, 7:00 a.m. to 3:30 p.m. The position requires a high school diploma or equivalent and at least three years of third-party payer or health care provider billing experience. Physician and/or facility billing experience and experience reconciling patient accounts and balancing payment transactions against contract rates and terms are also required.

Requirements

High school diploma or equivalent.
At least three years of third-party payer or health care provider billing experience.
Physician and/or facility billing experience.
Experience reconciling patient accounts and balancing payment transactions against contract rates and terms.
Skill using Microsoft Office, including Word, Excel, and Outlook.
Skill performing 10-key data entry.
Verbal and written communication skills.
Knowledge of patient accounting software and payer websites.
Knowledge of Universal Billing (UB) and Healthcare Financing Administration (HCFA) billing formats.
Knowledge of ICD, CPT, revenue codes, and DRG methodology.
Knowledge of facility contracting rates, CMS, and WPS ANSI remark codes.
Ability to maintain confidentiality and read and understand payer explanations of benefits.
Ability to use basic accounting and math principles, identify, trend, and analyze data, and learn new software programs.
Ability to organize and prioritize work, work independently, and identify and trend issues to improve or streamline processes.

Nice To Haves

College courses in accounting and/or health care.
Coursework in medical terminology.
At least one year of lead or supervisor experience.
Experience with government and managed care contracts and government regulations.

Responsibilities

Serve as a resource for resolving payer claim payment and denial issues, working with necessary staff to achieve closure.
Reconcile payer explanations of benefits and payments to determine whether reimbursement complies with fee schedules.
Work with payers or patients to obtain contractual payments when discrepancies are discovered.
Maintain working knowledge of payer-specific regulatory issues, insurance updates, and departmental functions.
Assist with new employee orientation and training, and provide feedback to employees and supervisors on work performance.
Keep management informed about denials, balances, and workflow issues.
Participate in process improvement activities and recommend ways to increase efficiency.
Develop and maintain documentation of work duties.
Perform duties of other departmental staff as needed to maintain productivity.
Test updates or changes to systems used in the department.