Denials Analyst

2 weeks ago


San Bernardino, California, United States NavitsPartners Full time
Job DescriptionJob Description

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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