The Denials Management Analyst will have responsibility for the management, reporting, recovery and prevention of clinical and technical denials received on Hospital services.
The Denials Management Analyst will report to Manager of Denials Management.
RESPONSIBITIES: The specific responsibilities include, but are not limited to:
- Develop, prepare, interpret and monitor financial analyses, financial projections, financial modeling, and reports used by management in decision-making.
- Assistance in performing extensive data mining and abstracting of financial and clinical information from various decision support tools including Epic, Huron Analytics and Tableau
- Provides direction to the other members of the team, serves as a resource for questions
- Reviews and researches claims in which a denial payment has been received from the payer
- Manages and Develops necessary department and executive level reporting
- Identifies the root cause of the denial and addresses the denial issue with the appropriate department (i.e. Billing, CDM, Clinical Documentation, Coding, etc.)
- Utilizes all appreciate systems to effectively research claims and complete steps to submit information necessary to process or appeal claims
- Investigates and ensures that questions and requests for information are responded to in a timely and professional manner to ensure resolution of outstanding claims
- Completes and requests adjustments to a claim, as appropriate, based on the dollar threshold of the adjustment
- Reviews, works and reports all claims that have aged more than the specified grace period stipulated in policies and / or contacts
- Organizes work/ resources to accomplish objectives and meet deadlines
- Demonstrates problem- solving skills related to denial analysis
- Demonstrates the willingness and ability to work collaboratively with other key internal and external staff, both clinically and administratively to obtain necessary information to address denial management issues
- Participates in all educational activities, and demonstrates personal responsibility for job performance
- Assists in the development of training material
- Uses supplies and equipment effectively and efficiently
- Consistently demonstrates a positive and professional attitude at work
- Meets productivity requirements to ensure excellent service is provided to customers
- Maintains compliance with established corporate and departmental policies and procedures
- Maintains stable performance under pressure and handles stress in ways to maintain relationships with patients, customers and co-workers
- Maintain satisfactory attendance and punctuality record as set forth by HSS policies
- Responsible for the other relevant work functions, as requested
EDUCATION AND CERTIFICATIONS:
- College experience required or business courses, including medical terminology, tying, word processing and knowledge of insurance companies
- Bachelors’ Degree preferred
- Minimum of 2-3 years business office experience in a healthcare environment and or a minimum of 1 year of HSS experience preferred
- Epic Certification preferred
EXPERIENCE AND COMPETENCIES:
- Payment variance or denials management experience is preferred
- Excellent phone etiquette and internal/external customer services skills required
- Demonstrates knowledge of insurance regulations and policies, payment policies/guidelines and the ability to communicate and work with payers to get claims resolved and paid accurately
- Expert level Excel experience required
- Microsoft Word and Power Point experience preferred
- Demonstrate in-depth knowledge and experience in the following technology solutions: patient accounting, optical imaging and scanning, patient systems and internet- based insurance websites
- Knowledge of denial management and contract reviews required
- Exceptional interpersonal and influencing skills; success at cultivating strong relationships with internal stakeholders and creating partnerships throughout the organization. Experience working with executive and medical leadership, especially physicians and their offices.
- Resolves issues through innovative problem solving and solution development; capable of gaining commitment to project goals.
- Stays current on healthcare industry trends and reform; can identify potential impacts and /or problems that may arise during conversion and translate them into remedial action plans.
- Outstanding communication skills: succinct and easy to understand, a good listener, skilled at influencing a variety of people. Capable of developing and implementing educational programs for a diverse audience.
- Unquestionable personal integrity. Exudes credibility and professionalism. Very likeable. Quickly builds confidence on others. Team player and understands his/her role in relationship to others.
- A highly committed individual, with the necessary drive and stamina to successfully oversee the denials management process.