Epic Denials Management Operator

Position Summary

Join Deloitte's AI & Engineering practice to support hospital denials management to deliver back-end Revenue Cycle Management (RCM) services, including Billing and Claims Submission, A/R Follow-up, Denials Management, Payment Posting, and Credits and Refunds, for health care provider client. This is a primarily remote role supporting enterprise Epic support, with minimal travel and scheduled onsite time as needed.

Work you'll do

• Support review denials (835/277 processing) received from third party payers.
• Categorize and root cause analyze denials based on remittance information received from payer.
• Review hospital account records and payer remittance records, communicate with relevant Client RCM and internal hospital stakeholders, and conduct outreach to payers through payer portals and phone calls to gather necessary information to understand denial reasons and root causes.
• Determine appropriate denial responses based on denial reasons.
• Develop denial appeal letters using appropriate templates and submit to third party payers.
• Rebill corrected claims and route issues to coding, billing, credentialing, denials, and/or clinical teams as needed.
• Provide additional documentation to payers as needed to resolve denial issues.
• Document denial details, research conducted, and follow-up activities conducted in relevant EMR and patient accounting systems.
• Review AR aging reports and work queues to identify unpaid and delayed claims.
• Follow up with third party payers on open denials, denial appeals, and other outstanding balances related to denials to understand claim status and payer requirements to adjudicate claim.
• Provide account information to payers and resolve issues related to eligibility, authorizations, claim edits, coordination of benefits, and missing documentation.
• Adhere to defined SOPs and workflows and work within Epic Resolute Hospital Billing, claims clearinghouse, payer websites and portals, and other systems and required by workflows.
• Meet and exceed minimum productivity and quality standards; submit to performance improvement plans as required according to guidance from engagement management.

Qualifications

• 2+ years of experience in hospital account denial management and appeals.
• Experience using Epic Resolute Hospital Billing.
• Bachelor's degree in information technology, business, healthcare, or a related field; or equivalent experience.
• Familiarity with Epic Analytics and Reporting applications.
• Experience managing multiple projects or workstreams.
• Experience preparing and delivering technical demonstrations.
• Experience analyzing billing workflows, claim issues, or operational data.