Denials Analyst

3 weeks ago

Rancho Mirage, United States BAHAMA Consulting Corporation Full time
Job DescriptionJob Description

TITLE: Denials Analyst

LOCATION: Rancho Mirage, CA ( Onsite )

SCHEDULE: Monday – Friday

PAY: $18 - $22/ hour

This is the pay range that BAHAMA Consulting reasonably expects to pay someone for this position.

FLSA STATUS: Non-Exempt

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 the Manager.
  • Attend all available coding and appeals related seminars as available.
  • All other duties as assigned.

EDUCATION & EXPERIENCE:

  • High School diploma or equivalent
  • 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: Associate degree
  • Preferred: Certified coder or currently enrolled in a coding program

Benefits: Medical, Dental, Vision, HSA, Employee Assistance Program (EAP), STD, LTD, Life and 401(K)

BAHAMA Consulting is an equal opportunity employer. If you need accommodation for any part of the application and hiring process or have any questions, please contact HR.


Monday – Friday

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