Denials Management AnalystBookmark This
DescriptionDescription : The Denials Management Analyst reports to the Denials Management Manager. Under general supervision and within Lifespan policies and procedures, ensures the appeals process for denied claims for the Lifespan affiliates are initiated in accordance with state and federal laws and payer contracts. Works to maintain third party payer relationships, a role that consists of responding to inquiries and other correspondence and may include setting up arbitration between parties. Communicates with physicians and their staff and various hospital personnel to increase awareness of denials and maximize denial prevention efforts.
Qualifications : Bachelor’s degree with emphasis in healthcare/business management/accounting or a combination of relevant education and experience. Rhode Island State nursing licensure in good standing preferred. Certification in billing and coding Minimum 3 years experience in healthcare billing, collections, payment processing or denials management (preferred) with use of computer programs for tracking denials and appeals. Demonstrated knowledge of Hospital/professional billing and reimbursement, Medicare and Medicaid denials and appeals, Third Party Contracts, NCQA guidelines for denials and appeals, Federal and sate regulations relating to denials and appeals, excellent critical thinking and analytical skills, strong organizational skills and attention to detail, ability to work effectively and efficiently under tight deadlines, high volumes and multiple interruptions. Ability to work independently and in a multi-disciplinary team. Strong verbal and written communication skills. Excellent interpersonal and customer service skills. Displays professionalism and commitment to the role.