PATIENT FINANCIAL DENIAL ANALYST

Job Locations US-AK-Juneau
Job ID
2021-5303
Category
ACCOUNTING/FINANCE/REVENUE CYCLE
Type
Regular Full-Time/80hrs (1.0 FTE)

About Us:

 

SEARHC is a non-profit health consortium which serves the health interests of the residents of Southeast Alaska. We see our employees as our strongest assets. It is our priority to further their development and our organization by aiding in their professional advancement.

 

Working at SEARHC is more than a job, it’s a fulfilling career. We offer generous benefits, including retirement, paid time off, paid parental leave, health, dental, and vision benefits, life insurance and long and short-term disability, and more.

Job Overview:

Under the general direction of the PFS Manager, performs a wide range of duties involving the analysis of accounts denied by insurance carriers. Identifies issues resulting in the denial of claims. Takes corrective action to facilitate the re-billing and/or appeal of claims and the subsequent reimbursement. Accurately analyzes and resolves any issues created throughout the verification, billing and follow up process. Serves as the primary feedback mechanism to determine if pre-registration and registration policies and procedures are being adhered to. Works closely with managed care organizations, third party payors and internal staff, to ensure compliance to individual contract requirements in order to expedite reimbursement of accounts and protect the consortium from unnecessary financial loss.

Responsibilities:

  1. Categorize denials based upon root cause findings and distributes reports and metrics to applicable management and teams.
  2. Compile and distribute denial and adjustment trending summaries to all stakeholders.
  3. Implement changes and provides education and feedback to providers, departments and clinics in relation to denials that impact revenue flow and/or capture.
  4. Proactively work with multidisciplinary teams within the consortium to develop procedures to reduce the number of denials received through reporting of denials and education of denial trends.
  5. Work as a liaison to assist billers in resolving complex denials and accounts problems that result in nonpayment of claims.
  6. Conducts relevant research on best in class methods to assist with completing the appeals process while staying informed with policy reforms, new regulations, billing changes, and accreditation/compliance requirements.
  7. Oversee daily, weekly, and monthly metrics as it pertains to Initial Denial rates, Overturn Rates, and controllable denial write-offs, etc. Work alongside the billing teams to create and monitor claim edits to increase denial prevention.

Qualifications:

Baseline Qualifications                       

  • High School diploma or equivalent; Bachelor’s degree in related field preferred
  • 5 years’ experience in billing, collections, and cash posting
  • Certified CRCR or CRCS or become certified within 2 years of employment.

Knowledge, Skills & Abilities

  • Advanced knowledge of payor remittances
  • Knowledge of medical terminology
  • Demonstrate basic knowledge of CPT’s, HCPCS, and Revenue Codes
  • Basic knowledge of major insurance companies billing policies to ensure compliance
  • Basic knowledge of insurance claim forms
  • General knowledge of specific specialties within the hospital or clinic billing area
  • Working knowledge of Microsoft Office Software programs
  • Knowledge of reconciling and balancing of payments received against account receivables
  • Proficient using a keyboard and 10 key
  • Highly motivated, self-starter
  • Attention to detail and accuracy
  • Good organizational skills
  • Good communication skills both orally and written
  • Problem solving and decision making skills
  • Ability to collaborate within cross-functional teams
  • Ability to work in a fast paced setting

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