Insurance Denials Analyst

ABOUT THE ROLE:

Responsible for monitoring payer denials, payment variances and ensuring system goals are maintained. Primary responsibilities of the position include identifying, appealing and monitoring payer denials, and collecting third party contractual underpayments. Analysis of the data, communication of findings and assisting in process improvement are all key components of this position.

YOUR ROLE WOULD ENCOMPASS:

• Commits to the mission, vision, beliefs and consistently demonstrates our core values.
• Deciphers various aspects of contract reimbursement and performs analysis on differences between expected and actual reimbursement.
• Prepares and analyzes reports used to oversee third-party payer activity, compares and interprets data to determine root cause of denials and uses the data to complete the appropriate resolution and implement efficiencies in the billing process.
• Provides information regarding payment discrepancies to the department manager.
• Participates in activities to identify and resolve patterns of incorrect payments by third-party payers. Contacts and resolves incorrect payments with payers, including escalating unresolved issues and managing communication with payer representatives.
• Analyzes denials and follows up on identified discrepancies; works with other areas to resolve any patterns or issues including root cause of underpayments and denials.
• Advises the department manager, revenue integrity staff, and alliance hospitals on regulatory changes which need to be addressed to optimize reimbursement or meet compliance.
• Acts as reimbursement advisor for department; advises revenue integrity staff and other departments regarding managed care contracts and proper payments.
• Responsible for completing appeals and payer audits, including participating in federal payer audits - Recovery Audit Contractors (RAC), Medicare Administrative Contractors (MAC), Comprehensive Error Rate Testing (CERT), and Quality Improvements Organizations (QIO).
• Identifies contract management errors and works with internal departments to ensure correct reimbursement data is available.
• Maintains professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest trends in field of expertise.
• Participates in meetings, committees and department projects as assigned.

YOUR EXPERIENCE INCLUDES (PROVEN PERFORMANCE IN):

• High School Diploma or equivalent - required
• Minimum of one (1) year college coursework in accounting, coding, insurance or related field - required
• Minimum of three (3) years insurance billing experience in a hospital or professional environment - preferred