Denial Analyst - Great Plains Health
North Platte, NE 69101
About the Job
Mission
To inspire health and healing by putting patients first - ALWAYS.
- Position Summary
- Responsible for the analysis, tracking, follow-up, coordination, and trending of all aspects of returned, unpaid, and/or denied claims. Based on root cause analysis, he/she makes recommendations for correcting processes creating the denials. Will follow denied claims through the appeal process until paid or considered uncollectible. Candidate must be able to handle potentially stressful situations and multiple tasks. Must be a positive role model for staff and patients by working with them to promote teamwork and cooperation. Exceptional leadership, communication and interpersonal skills are required in order to effectively interact with staff, management, third party parties, and patients. Must be able to influence leaders without having the direct authority to enforce recommendations.
- Minimum Qualifications
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Education
- High school degree or equivalent required
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Credentials
- None
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Education
- Physical Demands
- Sit constantly
- Stand/walk frequently
- Lift floor to waist height 30 pounds occasionally; waist to waist 25 pounds occasionally; waist to overhead 20 pounds occasionally. And carry 10 pounds up to 25 feet occasionally.
- Reach overhead frequently standing and turn reaching shoulder height while sitting frequently.
- Fine motor coordination within normal limits for age and gender.
- Constant computer use.
- Visual acuity within normal limits.
- Essential Functions
- Analyze and examine the “root causes” of denials, underpayments, and delay in payment. Take “ownership” of the job and provides useful information to minimize issues and streamline work processes.
- Write appeals and coordinates appeal efforts on fully denied claims with other staff as appropriate.
- Actively search for solutions to problems and continually brings ideas and recommendations to the PFS Manager.
- Co-ordinate with the PFS Manager and other departments to develop procedures and prioritize department efforts to reduce denials.
- Routinely review all commercial accounts over 90 days from discharge date to identify trends causing payment delay and report these trends. Review and report to PFS Manager any accounts within 30 days of hitting a timely filing denial.
- Responsible for tracking denials on a database and reporting results back to PFS Manager and the Denial Committee monthly.
- Must demonstrate strong interpersonal and persuasive abilities in order to establish and maintain a positive relationship with PFS staff, department directors, third party payors, government agencies, vendors, and physicians.
- Works with the appropriate person to implement and evaluate on-going training of staff regarding denials.
- Acts as PFS liaison with payer representatives and monitors for payment performance.
- Compiles, maintains and distributes reports to management on success of appeals and root cause analysis. Serves as a department resource related to denials and payer requirements.
- Interpreting payment and denial data down to the line item detail, identifying payer and coding trends, risks, and opportunities to implement operational or systemic improvements.
PI240084624
Source : Great Plains Health