Revenue Cycle Denials Specialist

6 days ago


Mt Vernon, Illinois, United States Skagit Regional Health Full time
Job Summary

The Revenue Cycle Denials Analyst will join the revenue cycle team at Skagit Regional Health and contribute to the team's overall goal of strengthening the financial health of the organization. The role will proactively analyze denials data to identify improvement opportunities and support developmental projects as needed.

Key Responsibilities
  • Manage and track claim denials related to medical necessity, prior authorization, non-coverage, coding error, referral, and other issues.
  • Carry out research and analysis to help with the appeals process and stay informed with best practices and policy changes.
  • Compile reports for revenue cycle and health system leadership, including the status and results of denials and appeals.
  • Track the kinds of claims denied and find their root causes.
  • Promote interdepartmental coordination for finding solutions and offer suggestions for improvements.
  • Make recommendations to improve processes and lessen the denials rate by suggesting additions, modifications, or deletions to work queues and claim edits.
  • Participate in the testing of system modifications; collaborate closely with department managers and IT personnel to ensure appropriate implementation.
  • Conduct clear, concise, and professional correspondence with payers and other stakeholders in accordance with organizational processes and expectations.
  • Examine payer correspondence and determine potential loss of reimbursement in relation to prior authorization requirements.
  • Submit retro authorizations in line with payer criteria.
  • Comply with accreditation/compliance standards, state and federal laws, and Skagit Regional Health's rules, particularly those pertaining to HIPAA, fraud and abuse, and confidentiality.
  • Serve as the primary point of contact for answering revenue cycle-related queries from hospital and clinic leaders.
  • Perform thorough analysis on revenue cycle denials for assigned departments.
  • Schedule meetings with clinical leadership/stakeholders on a recurring basis and present department-specific performance data to them.
  • Develop action items and/or follow-up plans in collaboration with revenue cycle and health system leaders and ensure completion within specified time frames.
  • Engage stakeholders from revenue cycle and other support departments as needed to develop and implement comprehensive projects aimed at improving performance of assigned clinical departments.
  • Identify trends in individual department performance and facilitate bidirectional conversations with them focused on mitigation of the root cause.
  • Stay updated on federal, state and organizational revenue cycle compliance regulations, including but not limited to those involving clinical documentation, charge capture, coding and billing.
  • Collaborate with Revenue Cycle leaders to prepare for and lead the Denials Committee Meetings.
Requirements
  • Bachelor's degree in billing, finance, accounting, data analytics, or related field required.
  • Minimum of five (5) years of medical billing and/or patient accounting experience in a clinic or hospital setting required.
  • Minimum two years of experience interdepartmental/multi-facility system preferred.
  • Revenue Cycle Certification such as, Certified Revenue Cycle Representative (CRCR) and Certified Revenue Cycle Professional (CRCP) strongly desired.
Preferred Skills
  • Excellent verbal, written & interpersonal communication skills.
  • Presentation of a professional demeanor, encouragement of participation & collaboration in an open approachable style with both internal & external customers.
  • Proactivity, high organization, detail orientation & ability to respond in an accurate and timely manner to project management needs.
  • Strong analytical/problem solving skills in order to assess project needs and develop multiple scenarios for solutions.
  • Solid judgment and personal responsibility and ownership of all work performed.
  • Ability to work independently and collaboratively.
Work Environment

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to sit for long periods of time when working in office. Repetitive tasks such as typing, sitting, answering phones, and interacting with computers and computer systems most of the day is a function of the position.

Benefits

Skagit Regional Health offers a comprehensive benefit package including medical, dental, vision, 457b/401a (retirement), long term disability, and paid time off to all employees holding an FTE of 20 or more hours per week. Eligible employees also receive sick time pay.



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