Denials Management Analyst
- Omaha, NE
- Permanent
- Full-time
At Nebraska Methodist Health System, we focus on providing exceptional care to the communities we serve and people we employ. We call it The Meaning of Care – a culture that has and will continue to set us apart. It’s helping families grow by making each delivery special, conveying a difficult diagnosis with a compassionate touch, going above and beyond for a patient’s needs, or giving a high five when a patient beats a disease or conquers a personal health challenge. We offer competitive pay, excellent benefits and a great work environment where all employees are valued! Most importantly, our employees are part of a team that makes a real difference in the communities we live and work in.Job Summary: Location: Methodist Corporate Office
Address: 825 S 169th St. - Omaha, NEWork Schedule: Mon - Fri, business hoursResponsible for review of denials for commercial / government, physician / facility and escalation of appeals to the payers as needed to obtain the maximum reimbursement in compliance to payer contracts and CMS regulations.Responsibilities:Essential Job Functions1. Analyze denials compared to the applicable contract agreements, payer medical policy language, NMHS coding and authorization processes.
- Analyze payments to ensure accuracy and initiate corrective action with third party payers.
- Demonstrates understanding of contract and reimbursement language.
- Maintain a follow up and reporting system to ensure receipt of reimbursement.
- Correct handling of denial.
- Resolve denial in RCA according to department policy.
- Timely follow-up of denials, appeals, etc.
- Respond to special requests with accurate information.
- Provide contract/payor recommendations.
- Assist with tracking payer agenda issues.
- High School Diploma or General Educational Development (G.E.D.) required.
- College coursework in accounting and or health care preferred.
- Minimum 1-2 years experience working for a 3rd party payer or health care provider required.
- Minimum 1 year of insurance billing experience preferred.
- Six months Institutional and Professional ICD and CPT coding preferred.
- Six months experience with DRG reimbursement and outpatient including ASC grouper, ER and outpatient reimbursement preferred.
- Experience in researching Institutional and Professional claims to determine correct contract reimbursement using payer contracts preferred.
- N/A
- Skill using Microsoft Office, including Word, Excel, and Outlook.
- Skill performing 10 key data entry.
- Skill with verbal and written communication.
- Knowledge of medical terminology.
- Knowledge of patient accounting software and payer websites.
- Knowledge of Universal Billing (UB) and Healthcare Financing Administration (HCFA) billing formats.
- Knowledge of International Classification of Disease (ICD), Current Procedural Terminology (CPT), Revenue Codes, understanding of DRG methodology.
- Knowledge of facility contracting rates.
- Knowledge of CMS (Center for Medicare and Medicaid Services).
- Knowledge of WPS ANSI remark codes.
- Ability to maintain confidentiality.
- Ability to read and understand payer explanation of benefits (EOB).
- Ability to use basic accounting and math principles.
- Ability to identify, trend and analyze data.
- Ability to learn new software programs.
- Ability to organize and prioritize work.
- Ability to work independently.
- Ability to identify and trend issues to improve or streamline processes.
- Ability to maintain a professional demeanor with internal and external contacts.
- Light Work - Exerting up to 20 pounds of force.
- Occasionally Performed (1%-33%):
- Balancing
- Climbing
- Carrying
- Crawling
- Crouching
- Distinguish colors
- Kneeling
- Lifting
- Pulling/Pushing
- Reaching
- Standing
- Stooping/bending
- Twisting
- Walking
- Frequently Performed (34%-66%):
- Hearing
- Repetitive Motions
- Seeing/Visual
- Speaking/talking
- Constantly Performed (67%-100%):
- Grasping
- Keyboarding/typing
- Sitting
- Not Related:
- Biological agents (primary air born and blood born viruses) (Jobs with Patient contact) (BBF)
- Physical hazards (noise, temperature, lighting, wet floors, outdoors, sharps) (more than ordinary office environment)
- Equipment/Machinery/Tools
- Explosives (pressurized gas)
- Electrical Shock/Static
- Radiation Alpha, Beta and Gamma (particles such as X-ray, Cat Scan, Gamma Knife, etc)
- Radiation Non-Ionizing (Ultraviolet, visible light, infrared and microwaves that causes injuries to tissue or thermal or photochemical means)
- Rare (1-33%):
- Chemical agents (Toxic, Corrosive, Flammable, Latex)
- Mechanical moving parts/vibrations
- Note: Safety Officer can assist with identification of job hazards