Denials Analyst

Job Objective

Researches and resolves claim denials, ADR requests and certs; submits and tracks appeals, notes trends and provides monthly reports. Responds to audit requests (including RAC) from payors and maintains a Library of Payer reference material regarding requirement for pre authorization, medical necessity and documentation requirements. Works with the Revenue Cycle stakeholders (e.g. Admitting, Coding, Provider Liaisons, etc.) to provide information related to denials and opportunities for process improvement.

Responsibilities

• Researches and resolves claim denials, ADR requests and certs; submits and tracks appeals
• Notes trends and provides monthly reports
• Responds to audit requests (including RAC) from payors
• Maintains a Library of Payer reference material regarding requirement for pre authorization, medical necessity and documentation requirements
• Works with the Revenue Cycle stakeholders (e.g. Admitting, Coding, Provider Liaisons, etc.) to provide information related to denials and opportunities for process improvement

Qualifications

• Knowledge of healthcare billing and coding practices
• Experience in resolving claim denials and ADR requests
• Ability to maintain and update payer reference material
• Strong communication and organizational skills
• Proficiency in Microsoft Office Suite

Skills

• Healthcare billing and coding knowledge
• Claim resolution and ADR request handling
• Payer reference material maintenance
• Communication and organizational skills
• Microsoft Office Suite proficiency

Benefits

• Flexible work schedule
• Professional development opportunities
• Competitive compensation package

Pay

Commensurate with experience

Schedule

TBD