Denials Analyst, Patient Accounting

Job Summary

Works collaboratively with physicians, staff and other health care professionals at all three acute care facilities to review, address and prevent denials—technical, medical necessity, and others. Collaborates with all revenue cycle team members on daily case issues as well as developing system-wide quality improvement/performance improvement initiatives. Identifies denial trends and develops appropriate plans to reduce.

BS/BA in Health Related Field or Finance preferred.

• Experience with hospital billing and collections processes, skills demonstrated in appealing and reducing denials
• Independent thinking and decision-making ability in appealing and reducing denials
• Excellent written, verbal, and interpersonal skills; ability to work in a team environment as well as independently
• Strong analytical skills necessary to collect, analyze and interpret denials data, resolve complex problems
• Preferred:
  Medical record audit and program development experience and public speaking, working knowledge of Interqual/Milliman admission criteria

• Provide guidance and support for all denials prevention.
• Actively manage, maintain and communicate denial / appeal activity to appropriate stakeholders and report suspected or emerging trends related to payer denials to Revenue Cycle management.
• Coordinates large dollar denials for follow-up.
• Work with PIC tool to identify and resolve payment variances
• Assist with the development and implementation of policies, procedures, standards and initiatives to reduce denials.
• Work with revenue cycle denials team to identify denials issues and processes to correct using the denial software tool.
• Actively participate in monthly revenue cycle denial meetings to help reduce overall denials.
• Reports any trending and process improvement initiatives to CFO and key stakeholders
• Collaborates in the ongoing re-design and re-engineering of Denial functions, to meet the changing needs and priorities of the organization.
• Working in the Cobius System: accurately entering data, running reports and identifying any denial trends.
• Other duties as assigned