Physician Billing Denial Anlayst-1

As the lead in the overall analysis of denials related to insurance accounts receivables, this Physician Billing Denial Analyst will act as the subject matter expert on payor policies as it relates to reimbursement, perform root cause analysis of denial categories, and implement workflows to mitigate denials.

Requirements

• Collaborates with payors, patients, internal contacts, and third-party follow-up vendors to identify and rectify denial issues resulting in timely reimbursement and final disposition of claims.
• Verifies accuracy of payment for correct reimbursement and resolves issues related to over/underpayments.
• Maintains knowledge of all regulations by continually enhancing education specific to federal regulations, payor communications, federal registrars, and contractual guidelines to ensure compliance.
• Participates in scheduled payor meetings by preparing and documenting open issues log (update balances, open A/R, discussion notes) and dispute spreadsheets.
• Prepare, submit, track, and maintain resolution of level II and III appeals.
• Works closely with Customer Service, Patient Relations, Risk Management, and Compliance to provide follow-up and direction with complicated account inquiries.
• Performs complex guarantor account reviews on all financial classes related to outstanding insurance claim balance.
• Actively participates in analysis of work processes; documents and provides feedback to assist in enhancing overall patient satisfaction and work process improvements.
• Participates actively in department meetings, providing updates to AR Teams and leadership.
• Assumes additional responsibilities and special projects as assigned.
• Collaborate with other departments to ensure smooth work processes (Consolidated Services, Accounts Payable, Finance, etc.).
• Act as an Epic Super User and Application/Task Tester for Physician Billing projects.
• Performs job functions adhering to service principles with customer service focus of innovation, service excellence, and teamwork to provide the highest quality care and service to our patients, families, co-workers, and others.

Benefits

• Medical, dental and vision insurance
• Employer paid group term life and disability
• Employer contribution toward Health Savings Account
• Flexible Spending Accounts
• Paid Time Off (PTO), Paid Holidays and Paid Parental Leave
• 403(b) with a 5% employer match
• Various voluntary benefits: