Denials Management Analyst

The Denials Management Analyst is responsible for analyzing denials data, creating payor metrics, as well as tracking and trending denials and result out of multiple systems. The analyst will identify and trend root causes and report out findings as well as assist in mapping out process improvement opportunities. The Analyst will coordinate payor denials and audit activities to ensure timely response for the processing of all payor denials, audit requests and appeals. The Analyst will communicate and coordinate with various individuals/distributions and assist with monitoring of the day-to-day activities related to claims denials and audit reviews.

Key Responsibilities

• Collecting/analyzing, report status, metrics and trends of activity by different reviews from multiple systems Distributing reports on a routine basis to specific distribution group

• Managing Epic work queues and resolving denials.

• Gathering data to substantiate the request for rule creations in Epic.

• Research payer fee schedules and provider manuals to ensure appropriate non covered denials.

• Organizing all data and activity in a retrievable way Coordinating payor denial and audit activities to ensure timely response for the processing of all payor denials, audit request and appeals for both institutional and professional claims

• Assisting with the coordination of denial and review activities and materials for committee meetings, including analyses, reports, etc.

• Communicating and coordinating with various individuals/distributions and assisting with monitoring of the day-to-day activities related to claim denials and audit reviews

• Maintaining the healthcare tracking tool/application that stores/communicates all denial and review activity. This will include user access management, updates to software, and end-user training

• Supporting projects and initiatives of the Denials Management Team. This may include coordinating meetings, conducting research, performing audits or data analysis, and preparing documents

• Strong communication skills and a commitment to delivering the highest level of quality work

Required Qualifications:

• Bachelor's degree, or equivalent combination of education and experience

• 5-7 Years in a Healthcare Revenue Cycle Environment including 3 years in Third Party Collection/AR Receivables and Denials Management

• Epic PB Resolute experience

• Healthcare Revenue Cycle management including:

  • Therapy (Physical/Occupational/Speech)

  • Radiology

  • Pediatrics/Pediatric Orthopedics

  • Anesthesia

• EDI Transaction sets including 837I, 837P

• Knowledge of insurance contract rates and terms

• Knowledge and understanding of Registration and Collections

• Knowledge and understanding of Government and Managed Care billing, coverage and payment rules

• Ability to comprehend payor 835 and paper EOB responses

• Knowledge and understanding of NCCI edits, CPT-4, HCPCS, ICD-10 and Revenue Codes standards

• Intermediate Excel skills

Preferred Qualifications:

• CRCR Certification

• Epic Certification

Originally posted on Himalayas