Schedule: 8 HR DAY
Facility: PT FINANCIAL SVCS
Date Posted: Jan 13, 2025
Description
Location: SGMC Patient Financial Services
Department: REVENUE CYCLE MEDICAL GROUP
Schedule: Full Time, 8 HR Day Shift, 8-5
POSITION SUMMARY
The Denials Management Analyst is responsible for thorough understanding of existing and future managed care payment methodologies such as fee for service and fee schedule in order to effectively analyze zero paid, underpaid, overpaid, and denied insurance claims. The analyst is responsible for timely and accurately interpreting all payer contracts and regulations to determine the correct payer denial. Responsible for determining the optimal combination of rebilling, collections, and follow-up activities to ensure correct reimbursement to include extensive phone, fax, and written correspondence with payers. This includes coordination with all payers, Professional Coders, Billers, Patient Access Services, Finance, Accounting and other departments as necessary. This position is responsible for timely and accurately reviewing and trending all payer contractual adjustment variances. Responsible for preparing all necessary support information, education material for clinic staff and providers. Responsible for identifying trends in denials. Daily review of claims to determine appropriate appeal or claim reprocessing/reconsiderations to represent correct processing of insurance claims. Responsible for knowing all timely filing deadlines for each designated payer and prioritizing denials appropriately.
KNOWLEDGE, SKILLS & ABILITIES
Modern, well lighted, air conditioned, general work area. Moderate noise level. Occasional overtime required. Ability to sit, stand or walk for moderate periods. Safe and efficient operation of office equipment including: copier, fax, printers, computer, telephone, adding machine, Medifax, credit card machine, typewriter, paper shredder. Reading of printed materials, including physician orders. Listening and verbally responding to customers, staff, physicians and visitors. Moderately heavy lifting {0-25 lbs.}, reaching, stooping, pushing, pulling, bending, and twisting.