Denials Analyst

3 weeks ago

Rancho Mirage, United States Select Source International Full time
Job DescriptionJob Description

Job Title: Denials Analyst

Location: 39000 Bob Hope Drive Rancho Mirage, CA 92270

Duration: 03+ Months

 

Requirements:

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 preauthorization, 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.

 

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.

 

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.

 

Required Skills:

  • 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.
Company DescriptionSelect Source International (SSI) is an IT, Health Care, and Engineering Services consulting firm that has been in business since 1998. SSI consultants have provided exceptional services that have been appreciated by clients, customers, and users alike at several large Fortune 500 companies, mid-size enterprises, and consulting companies.Company DescriptionSelect Source International (SSI) is an IT, Health Care, and Engineering Services consulting firm that has been in business since 1998. SSI consultants have provided exceptional services that have been appreciated by clients, customers, and users alike at several large Fortune 500 companies, mid-size enterprises, and consulting companies.

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