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Medical Claims Analyst

4 months ago

Palm Springs, United States Synergy Interactive Full time

Synergy Interactive is partnering with a Palm Springs-based medical group to fill a Denials Analyst position. This ongoing contract position is fully onsite in Palm Springs and requires previous experience in Managed Care denials and appeals as well as claim audit requests from payers. CPT, HCP, and ICD 10 coding ideal.

NOTE: NO 3RD PARTY CANDIDATES OR RESUME SOLICITATIONS WILL BE ACCEPTED

Responsibilities

  • Research and resolve claim denials, ADR requests, and certs
  • Submit and track appeals, noting trends, and providing monthly reports
  • Respond to audit requests from payors, including RAC
  • Maintain a library of payer reference material on pre-authorization, medical necessity, and documentation requirements
  • Collaborate with Revenue Cycle stakeholders to provide information on denials and future denial opportunities
  • Analyze denied, underpaid, and unpaid claims, and appeal as necessary
  • Track and report on denial trends
  • Maintain an appeals database to report outcomes and opportunities
  • Identify and report billing/coding trends resulting in denials to the Coding Manager
  • Identify and report other denial trends to the Manager
  • Comply with the Code of Conduct and resolve compliance issues

Qualifications

  • Minimum two years in Professional Billing, focusing on Managed Care denial follow-up and appeals processing
  • Preferred: Three to five years in Patient Accounting in a high-volume environment
  • Hospital billing experience is a plus
  • Strong analytical skills and proficiency in Microsoft Windows, especially Excel
  • Ability to prioritize, coordinate workflow, and maintain attention to detail
  • Knowledge of CPT, HCPC, and ICD-10 coding requirements, with emphasis on modifiers and diagnosis association
  • Working knowledge of LCDs, NCCI, and MUE edits
  • General knowledge of Commercial, HMO, and Medicare Advantage claims, authorization, and documentation requirements