Denials Analyst

4 weeks ago

Rancho Mirage, United States Comrise Full time

Overview

  • 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.


Responsibilities:

  • 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.


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 2 years of Professional Billing with an emphasis in Managed Care denial follow up and appeals processing Prior hospital billing experience a plus.
  • Preferred: 3-5 years of Patient Accounting in a high volume environment.
  • 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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