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Denials/ Claims Analyst
4 months ago
We are hiring a Denials/ Claims Analyst.
Our Major Hospital Client is looking for a Denials/ Claims Analyst in Rancho Mirage, California for a 3+ months contract on W2.
Please let me know if you are interested or anyone who might be interested.
Job Details:
Client: Major Hospital Client
Duration: 3+ months
Location: Rancho Mirage, California
Title: Denials/ Claims Analyst
Pay Rate: $21.00 - $23.00 Hr on W2 ONLY
Job Objective:
Responsible for researching and resolving claim denials, ADR requests and certs, submitting and tracking appeals, noting trends and providing monthly reports.
Responds to audit requests (including RAC) from payors.
Maintains a Library of Payer reference material regarding requirement 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.
Qualifications
Education
Required: High School diploma or equivalent
Preferred: Associate degree
Licensure/Certification
Preferred: Certified coder or currently enrolled in a coding program
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 a plus.
Preferred: three to five years of Patient Accounting in a high volume environment
Specific Skills, Knowledge, Abilities 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.
Essential Responsibilities
Demonstrates compliance with Code of Conduct and compliance policies, and takes action to resolve compliance questions or concerns and report suspected violations
Analyze denied, underpaid and unpaid claims. Appeal underpaid and denied claims within timely filing periods
Identify, track and report on denial trends
Maintain an appeals data base to identify and report outcomes and opportunities
Identify any billing and/or coding trends resulting in denials and report to the Coding manager
Identify any other trends resulting in denials and report to Manager.
Attend all available coding and appeals related seminars as available
All other duties as assigned
