R1 RCM · 6 hours ago

Denials & AR Senior Analyst

United States

Full-time

Remote

Senior Level

$16.88/hr - $24.79/hr

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Responsibilities

Investigating and analyzing claims to identify denial reasons.

Drafting complex and contractual appeals and letters to insurance companies.

Utilizing strong attention to detail to calculate expected claim reimbursement and notate accounts with updates received via email/phone from insurance companies.

Approve cases eligible for clinical review.

Assist with training of employees and provide necessary feedback as requested by management.

Approve and review cases for external appeal and outpatient billing.

Be an alternate point of contact for provider status inquiries.

Review EOB’s and provider systems to obtain payment information and apply the proper payments to accounts for billing.

Communicate all employee issues or potential areas of concern to department supervisor immediately.

Identify whether a claim has been under or over paid based on the provider’s expected reimbursement.

Determine if underpayments are based on patient responsibility.

Maintain an understanding of DRG, per diem, case rates and other relevant insurance reimbursement schematics.

Apply provider specific reimbursement methodologies, payment policies and provider contracts to each payment reviewed to confirm payment in full.

Meet all weekly performance standards and goals set by management.

Qualification

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

Denials experienceAR experienceWriting appeal lettersClaim analysisDRG understandingReimbursement methodologiesTraining employees