DENIALS MANAGEMENT ANALYST, REVENUE CYCLE MEDICAL GROUP

About the role

The Denials Management Analyst is responsible for analyzing insurance claims, coordinating with various departments, and ensuring accurate reimbursement.

Responsibilities

• Thoroughly understand managed care payment methodologies and payer contracts
• Analyze zero paid, underpaid, overpaid, and denied insurance claims
• Determine optimal rebilling, collections, and follow-up activities
• Interact with payers, professional coders, billers, patient access services, finance, accounting, and other departments
• Trend payer contractual adjustment variances and prepare necessary support information
• Review and trend all payer contractual adjustment variances
• Identify trends in denials and prepare support information for clinic staff and providers
• Process appropriate appeal or claim reprocessing/reconsiderations
• Prioritize denials based on timely filing deadlines
• Ensure correct processing of insurance claims

Requirements

• Knowledge of insurance/managed care, including Medicare, Medicaid, Tricare, VA, and commercial managed care plans
• Understanding of CPT-4, HCPCS, and ICD-10
• Reimbursement methodologies: percent of charges, fee-for-service, and fee schedule
• Knowledge of medical terminology and related regulatory and legal requirements
• Strong verbal and written communication skills
• Ability to prioritize work and be highly organized
• College degree or coursework preferred
• CPAR preferred
• Type 40 wpm accurately
• Clinical background beneficial
• Professional coding background preferred

Benefits

• Low Healthcare Insurance Premiums
• 401(k) with employer match
• Paid Time Off (PTO)
• Employee discounts
• Company paid life insurance
• Short-Term and Long-Term Disability
• Cancer Insurance
• Accident Insurance
• Pet Insurance
• Tuition Reimbursement
• On-the-job training and skills development
• Opportunities for growth and advancement
• Employee Assistance Program

Pay

Details about pay are not specified in this job posting.

Schedule

The position is full-time, 8-hour day shift from 8:00 AM to 5:00 PM.