Hybrid Denials Analyst

at Northeast Georgia Health System

• Job title: Denials Analyst
• Job type: Full Time
• Experience level: Mid level, Senior
• Salary: Not specified
• Degree requirement: High School Diploma
• Location requirements: Hybrid, Gainesville, United States

About the role

• Denials Analyst ensuring correct identification and resolution of payer denials. Working with insurance companies and the department manager to reduce denials at Northeast Georgia Health System.

Responsibilities

• Ensures correct identification and root cause of payer denials.
• Initiate comprehensive appeal process to include contacting insurance companies to justify and resolve denials.
• Work closely with the department manager on trending and reducing denials.
• Communicates appropriately to "Source Department" of denials to educate and troubleshoot.
• Evaluate MedAssets Contract Manager expected reimbursement calculation to final payer payment.
• Acts as subject matter expert for multiple, complex payer contracts.
• Manages a working inventory of identified payment discrepancies and denials for payment resolution.
• Analyzes payer denials and provide appropriate feedback to department manager when trends are identified.
• Identifies and corrects internal issues, such as incorrect revenue codes billed.
• Serves as payer liaison between the variance collections department and other departments.
• Pursues additional net revenue due to NGMC as a result of denied claims.
• Prepares and submits correspondence to fully explain reasons for appeal.
• Documents results of appeal process for accuracy.
• Reports contract compliance to appropriate parties as required.
• Follows up and escalates issues to upper management as needed.
• Attends payer meetings to present problem accounts.
• Collaborates on special projects to ensure appropriate contract compliance.

Requirements

• High School Diploma or GED
• Three or more years of medical experience including any of the following: insurance, follow-up, verifications, collections, triaging, coordinator or scheduling experience.
• Working knowledge of managed care contracts, HCPCS, DRG and other billing and reimbursement methodologies
• Understanding of ANSI claim adjustment reason codes and ANSI remittance advice remark codes
• Expert knowledge of UBO4 and EOB experience, knowledge with calculating expected reimbursement for hospital claims
• Extensive understanding of Managed Care reimbursement methodology with the ability to analyze Managed Care Contracts
• Expert knowledge of the patient accounting system, knowledge in Managed Care and billing practices revenue codes and CDM Codes

Benefits

• Health insurance
• 401(k) matching
• Flexible work arrangements
• Professional development opportunities