Denial Analyst

Denial Analyst

Location: 39000 Bob Hope Dr, Rancho Mirage, CA 92270

Duration: 03+ months with possible extension

Facility: Eisenhower Medical Center

Job type: Onsite

Shift timing: 8:30 AM - 5:00 PM | Monday Friday

Position Summary:

• Responsible for researching and resolving claim denials, ADR requests, and certs, submitting and tracking appeals, noting trends and providing monthly reports.
• Respond to audit requests (including RAC) from payors.
• Maintains a Library of Payer reference material regarding requirements for pre-authorization, medical necessity and documentation requirements.
• Works with the Revenue Cycle stakeholders (e.g. Admitting, Coding, Provider Liaisons, etc.) to provide information related to denials and opportunities for future denials

Required Education:

• High School diploma or equivalent

Preferred:

• Associate degree

Specific Skills, Knowledge, Abilities Required:

• Strong Analytical skills, Proficient in Microsoft Windows with emphasis on Excel.
• Ability to prioritize and coordinate workflow and attention to detail.
• Knowledge of CPT, HCPC and ICD 10 coding requirements with emphasis on modifiers and diagnosis association.
• Working knowledge of LCD's, NCCI and MUE edits as well as a general knowledge of Commercial, HMO, and Medicare Advantage claims, authorization and documentation requirements.