Claim Denial Analyst Job

Children's Health - Finance Careers

Job Number: 51947

Location: Dallas, TX

Date Posted: 6-3-2017

Description:

POSITION SUMMARY:

Supports claims denials reductions and increased revenues through process re-design, root cause analysis, metric/report development and special projects related to claim denials and underpayments. Prepares denial data to support all internal projects, documents root cause data, identify denial/revenue trends, and follows up on escalated issues until closing of project.

JOB PROFILE:

The following describes the basic position duties that an employee MUST be able to perform for this role. This information is intended to be descriptive of the key responsibilities of the position. The list of essential functions below DOES NOT identify all duties performed by any single person in the position.

Requires experience in own professional discipline to appropriately apply own knowledge; broadens own professional expertise and acquires higher level skills

Understands key business drivers; uses this understanding to accomplish own work

No supervisory responsibilities but may provide informal guidance to new team members

Solves problems in straightforward situations; analyzes possible solutions using professional/technical experience, judgment and precedents

Impacts quality of own work and the work of others on the team; works within guidelines and policies

Receives a moderate level of guidance and direction

Explains complex information to others in straightforward situations

JOB SPECIFIC RESPONSIBILITIES:

Serve as a claim denial subject matter liaison between operations and other departments to identify issues and optimize resolution.

Develop, implement and/or recommend claim denial root cause reporting as appropriate. Perform quality control for data related to denials/underpayment of reimbursement.

Identifies, tracks, analyzes and researches frequent root causes of claim denials in Epic and develops corrective action plans for resolution of denials

Develop and maintain an effective relationship with internal customers. Work with the billing team to provide root cause analysis for all problem claims.

Provide frequent project updates to Manager

Develop detailed reports to support performance and strategic business initiatives

Keep abreast of all payor updates, expected reimbursement process and bulletins

Ensure all escalated issues are addressed and reported.

Process account information and a variety of other forms of documents by resolving inconsistencies and reviewing data for errors using the Billing Department’s standard billing and data entry policies and procedures.

Perform other duties as assigned or required.

EXPERIENCE:

5 Years health care experience in Patient Access and/or Patient Financial Services required.

5 Years of Epic experience in patient access, health care billing, claims and/or denial management required.

Demonstrated proficiency in relevant software applications, including Microsoft Word, PowerPoint and Excel required.

EDUCATION:

Two-year Associate's degree or equivalent experience required.

LICENSES and CERTIFICATIONS:

CHAA - Certified Healthcare Access Associate preferred.

Specific Knowledge, Skills and Abilities:

Assimilate and apply new job-related information in a timely manner.

Use appropriate interpersonal styles to establish effective relationships with customers and internal partners; interact with others in a way that promotes openness and trust and gives them confidence in one's intentions.

Develop and use collaborative relationships to facilitate the accomplishment of work goals.

Identify and understand issues, problems, and opportunities; compare data from different sources to draw conclusions; use effective approaches for choosing a course of action or developing appropriate solutions; take action that is consistent with available facts, constraints, and probable consequences.

Take prompt action to accomplish objectives; take action to achieve goals beyond what is required; be proactive.

Deal effectively with others in an antagonistic situation; use appropriate interpersonal styles and methods to reduce tension or conflict between two or more people.

Effectively manage one's time and resources to ensure that work is completed efficiently.

Accomplish tasks by considering all areas involved, no matter how small; showing concern for all aspects of the job; accurately checking processes and tasks; being watchful over a period of time.

Set high standards of performance for self and others; assume responsibility and accountability for successfully completing assignments or tasks; self impose standards of excellence rather than having standards imposed.

Assimilate and apply new job-related information in a timely manner.

Clearly convey information and ideas through a variety of media to individuals or groups in a manner that engages the audience and helps them understand and retain the message.


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