Follow-Up Denials Analyst (Remote Candidates Considered)
Full Time
Hyannis, MA
Posted
Job description
Follow Up/Denials Analyst is responsible for actively supporting the execution of strategic initiatives, process re-design, root cause analysis, metric and report development, creation of educational materials and special projects as it relates to denials prevention and management. The Analyst role will develop, monitor and report defined denial metrics that support network and system wide initiatives and assist in the facilitation of the reduction of denial trends and other revenue leakage.
Description:
- Produce reports that provide denial details and patterns to drive root cause identification and resolution for prevention and process improvement.
- Responsible for coordinating efforts with Revenue Cycle and Clinical departments in developing root cause resolutions/process improvement initiatives for implementation. Monitors the implementation process to validate improvement.
- Proactively works with cross-functional teams within Cape Cod Health to develop or improve workflows to reduce the number of denials received. Develop plan to communicate, educate/train, implement, drive and support workflow enhancements.
- Facilitates meetings as they relate to denials management, education, and implementation of root cause corrections and/or workflow improvements. Facilitates coordination between and among revenue cycle departments and clinical departments to identify & mitigate denial trends. Manages the implementation and testing of denials-related technical updates/enhancements
- Works with Cape Cod PHO Department to understand payor contract interpretation. Creates and maintains payor specific educational correspondence and distributes to Revenue Cycle and Clinical teams. Continuously reviews applicable payor regulations, updates, maintains and trains on current understanding. Researches federal and state mandates as they relate to billing and denials.
- Consistently provides service excellence to all patients, family members, visitors, volunteers and co-workers.
- Challenges current working practices; identifies process improvement opportunities and presents recommendations and solutions to management. Engages and commits to the organization’s culture of continuous improvement by actively participating, supporting, and promoting CCHC Pillars of Excellence.
Qualifications:
- Associate’s or bachelor’s degree in Business or related field, or a combination of education and work experience.
- One (1) to three (3) years’ experience in Insurance, Follow-Up, Collections or Denials Management preferred.
- Must have demonstrated knowledge of collections management.
- Must be able to manage claim denial activities.
- Must have a good understanding of reimbursement methodologies and terms.
- Must understand payer billing requirements.
- Work requires familiarity working with contracts and payment rules.
- Epic experience preferred (e.g. Resolute).
- Excellent interpersonal, problem solving, and critical thinking skills are required.
- Excellent PC skills with a strong emphasis on the Outlook suite of products are required.
- Excellent verbal and written communication skills are required.
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