Denials, Credit​/Refund Analyst - Remote

Overview

Remote Denials, Credit / Refund Analyst. The role works in partnership with department leadership, vendors, and internal and external customers to resolve and/or improve hospital patient account revenues related to hospital billing and collections. Provides team support as a hospital billing and follow up subject matter expert, performing patient account audits, supporting team training tasks, and participating in root-cause analysis in accounts receivable work groups.

Performs department data analytics in support of trending, root cause analysis, and proactive identification of hospital accounts receivable risks. Interprets complex hospital commercial, managed care, and government payer contracts, including reimbursement methodologies and payment terms, to audit patient accounts, validate claim adjudication, and identify underpayments, over payments, and systemic contract issues. Presents findings and recommendations to Revenue Cycle leadership to support operational decision-making and denial prevention strategies.

Monitors payer guideline changes in partnership with department leadership. Analyzes and presents findings of hospital patient account system workflow and/or claim adjudication issues to Revenue Cycle Leadership with recommendations to remediate or resolve. Creates, supports, and partners in design for system tickets supporting hospital “clean claim” submissions and workflow optimization. Develops hospital account data reports required for accounts receivable analysis in collaboration with department leadership.

Provides department administrative support creating and gathering data reports, insurance or vendor correspondence related to patient account management, and co-facilitates team meetings related to insurance claim processing and/or workflow changes. Participates in development and delivery of hospital billing and follow-up training and workflows.

• Seven (7) years of related experience, education/training, OR a Bachelor’s degree in a related area plus three years of related experience/training. Related experience includes hospital billing, denials management, credit balance/refund adjudication, Epic HB/PB claims workflows, payer policy interpretation, contract review, and coding/billing regulatory compliance.

• Thorough knowledge of healthcare revenue cycle practices, procedures, and concepts, including billing, collections, charge capture, contractual adjustments, third-party reimbursements, and cash management.

• Thorough understanding of the issues, processes, reporting instruments, metrics, analytics, and tools used to measure and analyze the revenue cycle.

• Detail oriented with strong time management, the ability to manage multiple priorities, and the ability to address complex, urgent issues as they arise.

• Strong skills in report development, dashboard design, and software tools specific to healthcare revenue cycle management; proficiency with databases, spreadsheets, and presentation software.

• Strong communications skills, with the ability to interpret and convey complex clinical finance information clearly. Ability to prepare compelling reports and presentations.

• Strong analytical and problem-solving skills, with the ability to evaluate workflows and propose innovative solutions.

• Strong interpersonal skills with the ability to collaborate on complex projects in a diverse, cross-functional team environment.

• Proven ability to work with managers as a technical resource, providing recommendations on regulatory changes and industry trends in revenue cycle management.

• EPIC experience.

• Experience performing medical record review and drafting hospital-level appeals.

• Experience evaluating payer refund requests and drafting formal refund denial/acceptance determinations.

• Hospital billing, credits/refunds, and follow-up tasks (including follow-up work queues) experience.

• Working knowledge of hospital commercial contracts, billing and coding guidelines.

• Experience auditing hospital patient accounts in relation to Revenue Cycle.

• Experience training others.

• Strong organization and time management skills to support patient accounting daily…