Insurance Denials Analyst

GENERAL SUMMARY:

The Reimbursement Recovery Specialist is responsible for monitoring payer denials and ensuring system goals are maintained. Primary responsibilities of the position include identifying, appealing and monitoring payer denials, and collecting third party contractual underpayments. Analysis of the data, communication of findings and assisting in process improvement are all key components of this position.

PRINCIPAL JOB FUNCTIONS:

1. *Commits to the mission, vision, beliefs and consistently demonstrates our core values.

2. *Monitors and analyzes various aspects of contract reimbursement and performs analysis on differences between expected and actual reimbursement.

3. *Generates reports used to oversee third party payer activity; researches and corrects any discrepancies

4. *Provides information regarding payment discrepancies to Patient Financial Services Director and to Finance Administration. Participates in activities to identify and resolve patterns of incorrect payments by third party payers; contacts and resolves incorrect payments with payers.

5. Analyzes denials and follows up on identified discrepancies; works with other areas to resolve any patterns or issues.

6. *Advises department director or other managers throughout the Medical Center, the Revenue Integrity Liaisons, and alliance hospitals on regulatory changes which need to be addressed to optimize reimbursement or meet compliance.

7. *Acts as billing advisor for department; advises Revenue Integrity Liaisons and other medical center departments regarding managed care contracts and proper payments.

8. Advances work knowledge by participating in continuing education in2services, reading periodicals/literature and seeking ongoing development opportunities.

9. Performs other related projects and duties as assigned.

(Essential Job functions are marked with an asterisk "*". Refer to the Job Description Guide for the definition of essential and non-essential job functions.) Attach Addendum for positions with slightly different roles or work-specific differences as needed.

EDUCATION AND EXPERIENCE:

High school diploma or equivalency required. Minimum of one (1) year college coursework in accounting, coding, insurance or related field required. Minimum of two (2) year patient accounts experience in a hospital or insurance environment required.