SGMC Health · 15 hours ago
DENIALS MANAGEMENT ANALYST, PATIENT FINANCIAL SERVICES
Valdosta, GA
Full-time
Onsite
Mid LevelSGMC Health is dedicated to improving community health through excellence and compassionate service. The Denials Management Analyst is responsible for analyzing insurance claims to ensure correct reimbursement and coordinating with various departments to support revenue growth.
Health CareHospitalMedical
Responsibilities
Thorough understanding of existing and future managed care payment methodologies in order to effectively analyze zero paid, underpaid, overpaid and denied insurance claims and also make recommendations for continued revenue growth
Timely and accurately interpreting all payer contracts and regulations to determine the correct payer denied, bundled, and underpaid line items
Determining the optimal combination of rebilling, collections, and follow-up activities to ensure correct reimbursement
Coordination with payers, Patient Financial Services, Patient Access Services, Finance, Accounting and other departments as necessary
Timely and accurately reviewing and trending all payer contractual adjustment variances
Qualification
Required
PC and Windows literacy required; prefer knowledge of, or experience with, EPIC HB Resolute and Microsoft Office applications
Extensive knowledge of insurance/managed care, to include: Medicare; Medicaid (Georgia and Florida); Medicaid CMO's, Peach Care; Tricare (Standard, Extra and Prime); VA; Medicare Managed Care; Blue Cross (Georgia, Florida, out-of-state and FEP)
Working knowledge of CPT-4, HCPCS, ICD-10, and DRG coding
Reimbursement methodologies: percent of charges; DRGs; discounted fee-for-service; fee schedule; cost-based; and per Diems
Must have a thorough understanding and knowledge of: patient type; financial class; insurance master; employer codes; admission source codes; relationship codes; accommodation, occurrence, value and condition codes
Related regulatory and legal requirements: Medicare Secondary Payer Questions; medical necessity; Medical Reviews and Appeals
Interacts with: patients; other departments; physician offices; acute medical care providers; insurance companies; employers; Medicare administrative contractors; utilization review companies; state regulatory agencies, GMCF, Medicaid
Knowledge of medical terminology
Strong verbal/written communication skills
Highly organized with the ability to prioritize work
Types 40 wpm accurately
Preferred
College degree or coursework preferred
CPAR preferred
Clinical background beneficial
Benefits
Low Healthcare Insurance Premiums
401(k) with employer match
Paid Time Off (PTO)
Employee discounts
Company paid life insurance
Short-Term and Long-Term Disability
Cancer Insurance
Accident Insurance
Pet Insurance
Tuition Reimbursement
On-the-job training and skills development
Opportunities for growth and advancement
Employee Assistance Program
Company
SGMC Health
SGMC Health is the most comprehensive health system serving South Georgia and North Florida.
Founded in 1955
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Ronald E. Dean, MBA, FACHE
President and Chief Executive Officer
John Moore
Senior Vice President and Chief Financial Officer
Company data provided by crunchbase