Denials Management Analyst

## Denials Management Analyst Apply:
Methodist Corporate Office - Omaha, NE:
Full time:
Posted Yesterday:
JR116355
** Why work for Nebraska Methodist Health System?
** 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, NE

Work Schedule:

Mon - Fri, 7:00am to 3:30pm     
* Able to work from home after successfully completing the training process and achieving acceptable quality and production goals.
Responsible 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 Functions
** 1. 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.
2. Analyze and research contractual and reimbursement issues and answers inquiries from internal and external sources.
* Correct handling of denial.
* Resolve denial in RCA according to department policy.
* Timely follow-up of denials, appeals, etc.
3. Assist staff with work volume as needed.
* Respond to special requests with accurate information.
* Provide contract/payor recommendations.
4. Participate in payer meetings and escalates payer issues.
* Assist with tracking payer agenda issues.
5. Provide training on contracts and reimbursement to other areas as needed.
*
* Schedule:

** Mon - Fri, 7:00am to 3:30pm
*
* Job Description:

**#
** Job Requirements
**** Education
* ** High School Diploma or General Educational Development (G.E.D.) required.
* College coursework in accounting and or health care preferred.
** Experience
* ** 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.
** License/Certifications
*** N/A
** Skills/Knowledge/Abilities
*** 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…