Reimbursement Analyst
2 months ago
At Methodist Health System, we are seeking a highly skilled Denials Management Specialist to join our team. This role is responsible for reviewing and resolving denials for commercial and government payers, as well as physician and facility claims. The ideal candidate will have a strong understanding of contract agreements, payer medical policy language, and coding and authorization processes.
Key Responsibilities- Analyze denials and ensure accuracy of payments, initiating corrective action with third-party payers as needed.
- Develop and maintain a follow-up and reporting system to ensure receipt of reimbursement.
- Research and resolve contractual and reimbursement issues, providing accurate information to internal and external sources.
- Assist staff with work volume as needed, responding to special requests and providing contract/payor recommendations.
- Participate in payer meetings and escalate payer issues, tracking agenda items and providing updates.
- Provide training on contracts and reimbursement to other areas as needed.
- High School Diploma or General Educational Development (G.E.D.) required.
- College coursework in accounting and/or healthcare preferred.
- Minimum 1-2 years of experience working for a third-party payer or healthcare provider required.
- Minimum 1 year of insurance billing experience preferred.
- Six months of institutional and professional ICD and CPT coding preferred.
- Six months of experience with DRG reimbursement and outpatient, including ASC grouper, ER, and outpatient reimbursement preferred.
- Experience in researching institutional and professional claims to determine correct contract reimbursement using payer contracts preferred.
- Strong analytical and problem-solving skills.
- Excellent communication and interpersonal skills.
- Ability to maintain confidentiality and handle sensitive information.
- Knowledge of medical terminology, patient accounting software, and payer websites.
- Ability to learn new software programs and adapt to changing systems.
- Strong organizational and time management skills, with ability to prioritize tasks and meet deadlines.
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