Denial Analytics

4 weeks ago

Rancho Mirage, United States Med Solutions LLC Full time

Are you a data-driven professional with a passion for healthcare and a knack for uncovering insights from complex data sets? Med Solutions LLC is seeking a talented Denial Analytics Specialist to join our dynamic team. This role offers a unique opportunity to contribute to the optimization of our healthcare services and improve patient outcomes by addressing and reducing claim denials.
- 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

**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.

**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.

**Join Us in Making a Difference**:
**Job Types**: Full-time, Contract

Pay: $21.00 - $23.00 per hour

Schedule:

- 8 hour shift
- Monday to Friday

Ability to Commute:

- Rancho Mirage, CA (required)

Ability to Relocate:

- Rancho Mirage, CA: Relocate before starting work (required)

Work Location: In person

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