Denials Analyst / Utilization Review / Full Time

Catawba • Hickory, NC

1d

About The Position

Position is responsible for working with various internal and external customers regarding review, research, and resolution of denied claims. This position will review accounts and take appropriate actions based on type of denial and department procedure and will be responsible for reprocessing claims, submitting appeals, and performing claim adjustments. Strong analytical skills needed to analyze denial and adjustment trends. Proficient knowledge of billing regulations, claim form requirements, and processes for payer sources, government, and non-government. Must work within contract language and have an understanding of healthcare reimbursement methodologies and language. Majority of time will be spent working within Meditech, payer websites, RCW, Microsoft Excel, performing data analysis, tracking, trending, and research.

Requirements

• Associates degree or relevant experience in utilization review or finance/revenue cycle, working denials, managed care contracting, or payor relations.
• Must possess a strong understanding of revenue cycle and managed care operations.
• Strong to advanced Microsoft Excel and analytical skills required.
• Intermediate level of Microsoft Word and PowerPoint.
• One year of applicable experience, if candidate has no experience, they must have completed a successful healthcare internship in Utilization Review and/or finance, revenue cycle, medical billing, or denial management. with good references or an extensive managed care or an analytical background.
• Knowledge of healthcare reimbursement with a familiarity of CPT codes, DRGs, ICD-9s, & billing methodology for hospitals and physician practices.
• An understanding of managed care contracts and experience in working denials and appeals is helpful.
• Demonstrated experience in problem-solving, critical thinking, accomplishing tasks on assigned timelines, and evidence of sound judgement.
• Excellent PC, Excel skills and ability to learn and use new software applications is important.
• Excellent communication and customer service skills.
• Given experience and on-the job training, incumbent should be proficient in the basic aspects of the position in three months of employment date.

Responsibilities

• Review, research, and resolution of denied claims
• Review accounts and take appropriate actions based on type of denial and department procedure
• Reprocessing claims
• Submitting appeals
• Performing claim adjustments
• Analyze denial and adjustment trends
• Work within contract language
• Data analysis, tracking, trending, and research

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: Associate degree