Revenue Cycle Denial Analyst

The Revenue Cycle Denials Analyst is responsible for researching, disputing, and appealing denied claims, as well as identify trends or patterns with insurance carriers. This position will also be responsible for coordination, analysis, tracking, and reporting of all denied and prepayment audits for all lines of business. This role will support execution of strategic initiatives, process re-design, root cause analysis, metric/report development and special projects as it related to denials management. Developing and delivering education to various process participants as part of continuous process improvement. This position reports to the Director of Patient Accounting.<br /><br />Job Requirements<br /><br />High School Diploma or equivalent is required.<br /><br />Minimum of 2 years’ experience working for hospital or physician patient accounting office<br /><br />Required Skills<br /><br />Knowledge of insurance billing, collection, and denial processes<br /><br />Understanding of insurance Explanation of Benefits<br /><br />Functional Demands<br />Physical Requirements<br />Sitting – Greater than 32%<br /><br />Walking - 1-15%<br /><br />Standing - 1-15%<br /><br />Climbing/Kneeling - 1-15%<br /><br />Twisting - 1-15%<br /><br />OSHA Category<br />Minimal Potential for Direct Body Fluid Exposure<br /><br />Visual and Hearing Requirements<br />Must be able to see with corrective eyewear.<br /><br />Must be able to hear clearly with assistance.<br /><br />Other Physical/Environmental Demands<br />Lifting - 0-50lbs, 50lbs or more with assistance<br /><br />Carrying - 0-50lbs, 50lbs or more with assistance<br /><br />Pulling - up to 100lbs<br /><br />Pushing - up to 100lbs<br /><br />Leadership Capabilities<br />Supports the hospital Mission, Service and Values.<br /><br />Essential Functions<br /><br />Compile, analyze, and report on data related to underpayments, denials, revenue opportunities, and revenue leakage on a regular basis<br /><br />Categorize denials based on root cause finding and distributes reports and metrics to applicable management and teams<br /><br />Compile and distribute denials and adjustment trending summaries to all stakeholders<br /><br />Research and analyze claims data and medical records information to determine the accuracy of payments<br /><br />Implement changes and provide education and feedback to providers, departments and clinics in relation to denials that impact revenue flow and or charge capture<br /><br />Prepares and files appeals as needed<br /><br />Monitors and follows up on claims not paid in a timely manner<br /><br />Readily identifies, analyzes, and resolves work problems<br /><br />Pays close attention to documentation in the medical record to support medical necessity of tests performed<br /><br />Responsible for coordinating timely response of all documentation requests and denials through coordination between all involved departments<br /><br />Proactively work with multidisciplinary teams within the organization to develop procedures to reduce the number of denials through development of best practices<br /><br />Collaborate with Health Information Management, Case Management, Patient Access, and clinical departments to resolve cases<br /><br />Continuously review applicable regulations, payer updates, and other applicable industry changes<br /><br />Knowledge of HIPPA awareness and compliance with emphasis on respect of the patients’ rights to privacy, dignity, and confidentiality<br /><br />Maintains annual Employee Health screening requirements as required by policy<br /><br />Other duties as requested and assigned<br /><br />Qualifications<br />Education<br />Required<br />High School or equivalent or better.<br /><br />Equal Opportunity Employer<br />This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.<br /><br />#J-18808-Ljbffr