Denials Analyst
2 weeks ago
Job Title: Denials Analyst
Unit: Denials Analytics
Location: Rancho Mirage, CA
Shift: 9 am- 5 pm
Job Duties:
- Responsible for researching and resolving claim denials, ADR requests, and certs, submitting and tracking appeals, noting trends, and providing monthly reports.
- Respond to audit requests (including RAC) from payors. Maintains a Library of Payer reference material regarding requirements for pre-authorization, medical necessity, and documentation requirements.
- Works with the Revenue Cycle stakeholders (e.g. Admitting, Coding, Provider Liaisons, etc.) to provide information related to denials and opportunities for future denials.
Experience:
Required: Minimum of two years of Professional Billing with an emphasis in Managed Care denial follow-up and appeals processing Prior hospital billing experience is a plus.
Preferred: three to five years of Patient Accounting in a high-volume environment
Requirement: High School diploma or equivalent
Preferred: Associate degree
Preferred Licensure/Certification: Certified coder or currently enrolled in a coding program
Skills Required:
- Strong Analytical skills, Proficient in Microsoft Windows with emphasis on Excel.
- Ability to prioritize and coordinate workflow and attention to detail.
- Knowledge of CPT, HCPC and ICD 10 coding requirements with emphasis on modifiers and diagnosis association.
- Working knowledge of LCD's, NCCI and MUE edits as well as a general knowledge of Commercial, HMO, and Medicare Advantage claims, authorization and documentation requirements.
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