Denials Management Analyst
Bestcare
- # Denials Management AnalystApply: Methodist Corporate Office - Omaha, NE: Full time: Posted Yesterday: JR116355**Why work for Nebraska Methodist Health System?** At Nebraska Methodist Health System, we focus on providing exceptional care to the communities we serve and people we employ. We call it The Meaning of Care – a culture that has and will continue to set us apart. It’s helping families grow by making each delivery special, conveying a difficult diagnosis with a compassionate touch, going above and beyond for a patient’s needs, or giving a high five when a patient beats a disease or conquers a personal health challenge. We offer competitive pay, excellent benefits and a great work environment where all employees are valued! Most importantly, our employees are part of a team that makes a real difference in the communities we live and work in.**Job Summary:**Location: Methodist Corporate Office Address: 825 S 169th St. - Omaha, NE Work Schedule: Mon - Fri, 7:00am to 3:30pm \\*Able to work from home after successfully completing the training process and achieving acceptable quality and production goals. Responsible for review of denials for commercial / government, physician / facility and escalation of appeals to the payers as needed to obtain the maximum reimbursement in compliance to payer contracts and CMS regulations.**Responsibilities:**# **Essential Job Functions**1. Analyze denials compared to the applicable contract agreements, payer medical policy language, NMHS coding and authorization processes.* Analyze payments to ensure accuracy and initiate corrective action with third party payers.* Demonstrates understanding of contract and reimbursement language.* Maintain a follow up and reporting system to ensure receipt of reimbursement.2. Analyze and research contractual and reimbursement issues and answers inquiries from internal and external sources.* Correct handling of denial.* Resolve denial in RCA according to department policy.* Timely follow-up of denials, appeals, etc.3. Assist staff with work volume as needed.* Respond to special requests with accurate information.* Provide contract/payor recommendations.4. Participate in payer meetings and escalates payer issues.* Assist with tracking payer agenda issues.5. Provide training on contracts and reimbursement to other areas as needed.**Schedule:**Mon - Fri, 7:00am to 3:30pm**Job Description:**# **Job Requirements****Education*** High School Diploma or General Educational Development (G.E.D.) required.* College coursework in accounting and or health care preferred.**Experience*** Minimum 1-2 years experience working for a 3rd party payer or health care provider required.* Minimum 1 year of insurance billing experience preferred.* Six months Institutional and Professional ICD and CPT coding preferred.* Six months experience with DRG reimbursement and outpatient including ASC grouper, ER and outpatient reimbursement preferred.* Experience in researching Institutional and Professional claims to determine correct contract reimbursement using payer contracts preferred.**License/Certifications*** N/A**Skills/Knowledge/Abilities*** Skill using Microsoft Office, including Word, Excel, and Outlook.* Skill performing 10 key data entry.* Skill with verbal and written communication.* Knowledge of medical terminology.* Knowledge of patient accounting software and payer websites.* Knowledge of Universal Billing (UB) and Healthcare Financing Administration (HCFA) billing formats.* Knowledge of International Classification of Disease (ICD), Current Procedural Terminology (CPT), Revenue Codes, understanding of DRG methodology.* Knowledge of facility contracting rates.* Knowledge of CMS (Center for Medicare and Medicaid Services).* Knowledge of WPS ANSI remark codes.* Ability to maintain confidentiality.* Ability to read and understand payer explanation of benefits (EOB).* Ability to use basic accounting and math principles.* Ability to identify, trend and analyze data.* Ability to learn new software programs.* Ability to organize and prioritize work.* Ability to work independently.* Ability to identify and trend issues to improve or streamline processes.* Ability to maintain a professional demeanor with internal and external contacts.# **Physical Requirements****Weight Demands*** Light Work - Exerting up to 20 pounds of force.**Physical Activity*** Occasionally Performed (1%-33%): + Balancing + Climbing + Carrying + Crawling + Crouching + Distinguish colors + Kneeling + Lifting + Pulling/Pushing + Reaching + Standing + Stooping/bending + Twisting + Walking* Frequently Performed (34%-66%): + Hearing + Repetitive Motions + Seeing/Visual + Speaking/talking* Constantly Performed (67%-100%): + Grasping + Keyboarding/typing + Sitting**Job Hazards*** Not Related: + Biological agents (primary air born and blood born viruses) (Jobs with Patient contact) (BBF) + Physical hazards (noise, temperature, lighting, wet floors, outdoors, sharps) (more than ordinary office environment) + Equipment/Machinery/Tools + Explosives (pressurized gas) + Electrical Shock/Static + Radiation Alpha, Beta and Gamma (particles such as X-ray, Cat Scan, Gamma Knife, etc) + Radiation Non-Ionizing (Ultraviolet, visible light, infrared and microwaves that causes injuries to tissue or thermal or photochemical means)* Rare (1-33%): + Chemical agents (Toxic, Corrosive, Flammable, Latex) + Mechanical moving parts/vibrations* Note: Safety Officer can assist with identification of job hazards
- J-18808-Ljbffr Bestcare
Vacancy posted 5 days ago
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