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Bryan Health · 11 hours ago

Insurance Denials Analyst

Lincoln, NE

Full-time

Onsite

Mid Level

3+ years exp

Bryan Health is seeking an Insurance Denials Analyst responsible for monitoring payer denials and ensuring system goals are maintained. The role involves identifying, appealing, and monitoring payer denials, as well as analyzing data to improve billing processes.

Health CareHospitalNon Profit

Responsibilities

Commits to the mission, vision, beliefs and consistently demonstrates our core values

Deciphers various aspects of contract reimbursement and performs analysis on differences between expected and actual reimbursement

Prepares and analyzes reports used to oversee third party payer activity, compares and interprets data to determine root cause of denials and uses the data to complete the appropriate resolution and implement efficiencies in the billing process

Provides information regarding payment discrepancies to Patient Financial Services Director and to Finance Administration

Participates in activities to identify and resolve patterns of incorrect payments by third party payers. Contacts and resolves incorrect payments with payers, including escalating unresolved issues and managing communication with payer representatives

Analyzes denials and follows up on identified discrepancies; works with other areas to resolve any patterns or issues including root cause of underpayments and denials

Advises department director or other managers throughout the Medical Center, the Revenue Integrity Liaisons, and alliance hospitals on regulatory changes which need to be addressed to optimize reimbursement or meet compliance

Acts as reimbursement advisor for Patient Financial Services; advises Revenue Integrity Liaisons and other medical center departments regarding managed care contracts and proper payments

Responsible for completing appeals and payer audits, including participating in federal payer audits – RAC, MAC, CERT, and QIO

Identifies contract management errors and works with internal departments to ensure correct reimbursement data is available

Maintains professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest trends in field of expertise

Participates in meetings, committees and department projects as assigned

Performs other related projects and duties as assigned

Qualification

Third party payer knowledgeBillingAccounts receivableCPTICD-10 codingRegulatory compliance knowledgeManaged care contracts knowledgeProblem analysisWork prioritizationEffective communicationConfidentiality maintenance

Required

High school diploma or equivalency required

Minimum of one (1) year college coursework in accounting, coding, insurance or related field required

Knowledge of third party payer (Medicare, Medicaid, insurance) pre-admission, admission and discharge guidelines, including billing requirements

Knowledge of third party requirements for appeal and reconsiderations

Knowledge of billing and accounts receivable management, including CPT coding, ICD-10 coding, revenue coding, DRG coding, APC coding, and EAPG reimbursement methodologies

Knowledge of regulatory agencies and corporate compliance requirements related to reimbursement

Knowledge of computer hardware equipment and software applications relevant to work functions

Knowledge of hospital managed care contracts, contract implementation standards and schedules

Ability to analyze problems, identify needs and priorities and implement effective work strategies and process efficiencies

Ability to collect, compare, sort and prioritize information to be used in analysis processes

Ability to prioritize work demands and work with minimal supervision

Ability to communicate effectively both verbally and in writing

Ability to consistently meet predetermined deadlines

Ability to establish and maintain effective working relationships with all levels of personnel, medical staff, ancillary departments and vendor representatives

Ability to maintain confidentiality relevant to sensitive information

Ability to maintain regular and punctual attendance