Denials Analyst/Specialist

3 weeks ago

Rancho Mirage, United States DB HEALTHCARE INC Full time
Job DescriptionJob Description

Title: Denials Analyst - CA
Type: Contract
Duration: 3 Months
Start Date: ASAP

Job Summary:
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.

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

Required Skills:

  • Minimum of 2 years of Professional Billing with an emphasis in Managed Care denial follow up and appeals processing

  • 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.

  • Knowledge of CPT, HCPC and ICD 10 coding requirements with emphasis on modifiers and diagnosis association.

  • Strong Analytical skills, Proficient in Microsoft Windows with emphasis on Excel.

  • Ability to prioritize and coordinate workflow and attention to detail.

Preferred Skills:

  • 3 to 5 years of Patient Accounting in a high-volume environment.

  • Prior hospital billing experience.

Education:

  • High School diploma or equivalent required

  • Associate degree preferred

  • Certified coder or currently enrolled in a coding program preferred

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