Revenue Cycle Denial Analyst

JOB SUMMARY

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.

JOB REQUIREMENTS

Minimum Education

§ High School Diploma or equivalent is required.

Minimum Work Experience

§ Minimum of 2 years’ experience working for hospital or physician patient accounting office

Required Skills

§ Knowledge of insurance billing, collection, and denial processes

§ Understanding of insurance Explanation of Benefits

FUNCTIONAL DEMANDS

Physical Requirements

Sitting – Greater than 32%

Walking - 1-15%

Standing - 1-15%

Bending/Squatting - 1-15%

Climbing/Kneeling - 1-15%

Twisting - 1-15%

OSHA Category

Minimal Potential for Direct Body Fluid Exposure

Visual and Hearing Requirements

Must be able to see with corrective eyewear.

Must be able to hear clearly with assistance.

Other Physical/Environmental Demands

Lifting - 0-50lbs, 50lbs or more with assistance

Carrying - 0-50lbs, 50lbs or more with assistance

Pulling - up to 100lbs

Pushing - up to 100lbs

LEADERSHIP CAPABILITIES

Supports the hospital Mission, Service and Values.

ESSENTIAL FUNCTIONS

§ Compile, analyze, and report on data related to underpayments, denials, revenue opportunities, and revenue leakage on a regular basis

§ Categorize denials based on root cause finding and distributes reports and metrics to applicable management and teams

§ Compile and distribute denials and adjustment trending summaries to all stakeholders

§ Research and analyze claims data and medical records information to determine the accuracy of payments

§ Implement changes and provide education and feedback to providers, departments and clinics in relation to denials that impact revenue flow and or charge capture

§ Prepares and files appeals as needed

§ Monitors and follows up on claims not paid in a timely manner

§ Readily identifies, analyzes, and resolves work problems

§ Pays close attention to documentation in the medical record to support medical necessity of tests performed

§ Responsible for coordinating timely response of all documentation requests and denials through coordination between all involved departments

§ Proactively work with multidisciplinary teams within the organization to develop procedures to reduce the number of denials through development of best practices

§ Collaborate with Health Information Management, Case Management, Patient Access, and clinical departments to resolve cases

§ Continuously review applicable regulations, payer updates, and other applicable industry changes

§ Knowledge of HIPPA awareness and compliance with emphasis on respect of the patients’ rights to privacy, dignity, and confidentiality

§ Maintains annual Employee Health screening requirements as required by policy

§ Excellent customer service skills

§ Other duties as requested and assigned