Denials and Appeals Analyst req12271

Denials And Appeals Analyst

Position Overview

The Denials And Appeals Analyst assists in the recovery of Health System revenue by bringing denied claims to full resolution. He / She works collaboratively with departmental peers throughout the System to achieve departmental and system-wide quality, satisfaction, and financial goals. The Denials And Appeals Analyst coordinates the appeals process for denials deemed appropriate by the Patient Financial Services Director and the Denials Manager. He / She assures that prompt action is taken on assigned denials by coordinating with clinical staff to create written and / or verbal clinical appeals with payers. The Analyst works closely with third party payors, Managed Care representatives, insurance billing staff, case management, and other service departments to resolve denied claims. He / She is a liaison and communicates denials related information and knowledge to Organizational Leaders.

Education

High School Diploma or equivalent required; Associate's degree preferred.

License

N / A

Certification

Epic certification in Resolute Hospital Billing and / or Certified Coding Specialist preferred. Must have de-escalation training completed by the end of position orientation (90 days); must have appropriate level of de-escalation training.

Experience

A minimum of five (5) years' patient accounting and insurance experience required. Experience in a hospital and / or physician office preferred.

Reports To : Denials Manager

Supervises : None

Physical Demands

Work is moderately active : involves sitting with frequent requirements to move about the office, move about the facility, and to travel to another facility within the SRHS service area. Work involves exerting a negligible amount of force frequently to lift, carry, push, pull, or otherwise move objects, including the human body. Work involves using many physical motions in performing daily work activities; subject to exposure of body fluids, sputum, and tissues, which may carry the hazard of infectious disease. Work involves using repetitive motions : substantial movements of the wrists, hands, and or fingers while operating standard office equipment such as computer keyboard. Work requires close visual and acuity and the ability to adjust the eye to bring an object into sharp focus, i.e. shift gaze from viewing a computer monitor to forms / printed material that are closer to compare data at close vision. Must be able to be active for extended periods of time without experiencing undue fatigue. Must be able to work schedules assigned with the understanding that changes may be instituted according to the needs of the hospital for off days, shifts or weekends.

Mental Demands

Must demonstrate keen mental faculties / assessment and decision making abilities. Must demonstrate superior communication / speaking / enunciation skills to receive and give information in person and by telephone. Must demonstrate strong written and verbal communication skills. Must possess emotional stability conducive to dealing with high stress levels. Must demonstrate ability to work under pressure and meet deadlines. Attention to detail and the ability to multi-task in complex situations is required. Must have the ability to maintain collaborative and respectable working relationships throughout SRHS and other organizations.

Special Demands

Must possess superior customer service skills and professional etiquette. Must possess proficient knowledge and ability to use a computer (must be keyboard proficient) and other office technology (i.e., telephone, fax, etc.), MS Outlook and Word. Job may require traveling throughout the SRHS service area - with the employee providing their own transportation. Travel for education purposes may be required.