Denials Analyst

Position Summary:

The Denial Analyst (DA) is responsible for the daily review and resolution of technical denials that are assigned to the analyst for resolution. The analyst monitors, researches and appeals all denials assigned providing the necessary information to the payer according to the prescribed process established by the payer. Provide information back to the denial manager for assessment prevention of future occurrence that caused the denial.

Qualifications:

Education:

High School Diploma required. Associated Degree in Healthcare or closely related field preferred. Experience Minimum two (2) years' experience in healthcare revenue cycle required. Minimum one (1) years' experience with Cerner Millennium preferred. Licensure/Certification/Registration Certificate of Medical Coding completion from a Medical Coding program preferred.

Duties & Responsibilities:

Monitors, research and/or resolves high dollar, high profile, and problem accounts, providing necessary information to various internal revenue cycle departments, clinical and corporate departments, and patients for resolution of account inquiries. ' Monitors, reviews, and provides analysis of all assigned work queues, dashboards and watch lists, payer communications and analysis, identifying trends and working with other departments to resolve system issues. Evaluates payer performance and payment trends to provide management with valuable statistics to facilitate improved payer relations and contracting criteria, identifies payer specific problem trends and works with clinical departments, outcomes management, managed care, reimbursement and PFS to rectify systematic issues. Recommends and assists in the development of regular training sessions with team members, to ensure the highest quality and productivity standards are achievable. Assists in the onboarding of new team members as well as providing ongoing support for all FS team members. Assists with identifying payer specific trends and works with revenue cycle, clinical and corporate departments, managed care, and reimbursement teams on resolution. Provide exemplary core customer service. Work effectively and collaboratively with colleagues, physicians, and department heads. Effectively utilize strong organizational skills. Consistently display effective verbal communication skills. Proficient understanding and use of technology/PC skills required. Regularly exercise independent judgement. Completes other duties as assigned by department leadership.