Children's Health · 19 hours ago

Claim Denial Analyst

Dallas, TX

Full-time

Remote

Mid, Senior Level

5+ years exp

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Responsibilities

Serve as a claim denial subject matter liaison between operations and other departments to identify issues and optimize resolution.

Develop, implement and/or recommend claim denial root cause reporting as appropriate. Perform quality control for data related to denials/underpayment of reimbursement by interpreting payer agreements, claims, and payer policy and procedures.

Identifies, tracks, analyzes and researches frequent root causes of claim denials in Epic and department system and develops corrective action plans for resolution of denials

Demonstrated ability to perform denial root cause analysis, draw conclusions, review process workflows, and prepare for Denial Management Director and Manager review

Develop and maintain an effective relationship with internal customers. Work with the billing team to provide root cause analysis for all problem claims.

Provide frequent project updates to Manager

Develop detailed reports to support performance and strategic business initiatives

Keep abreast of all payor updates, expected reimbursement process and bulletins, including contacting payers to obtain additional information related to the denial.

Ensure all escalated issues are addressed and reported.

Process account information and a variety of other forms of documents by resolving inconsistencies and reviewing data for errors using the Billing Department’s standard billing and data entry policies and procedures.

Perform other duties as assigned or required.

Actively participate in denial review department meetings and multi-department workgroups by providing detailed insight into denial causes.

Qualification

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EpicPatient AccessDenial ManagementHealthcare BillingRoot Cause AnalysisMicrosoft WordMicrosoft PowerPointMicrosoft ExcelCHAA CertificationData AnalysisQuality ControlProject Management