Revenue Integrity Analyst I- Denial Management (Hb

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Location
BHG Bronson Healthcare Group
Title
Revenue Integrity Analyst I- Denial Management (HB
The Denials Management Specialist assesses and utilizes clinical and financial information in relation to appealing, trending, and educating the Bronson Healthcare Group (BHG) system on retrospective denials and /or non-payment of claims. In partnership with patients, physicians and other health care providers, support the utilization of resources and obtain optimal reimbursement to assure maximum appropriate reimbursement for the organization. This includes reviewing denials of reimbursement based on medical necessity utilizing professional knowledge, expertise, application of reimbursement methodology, third-party contract language and industry accepted criteria and guideline sets (i.e., Interqual). Responsible for creating effective appeal letters utilizing relevant and effective clinical documentation from the medical record. Employees providing direct patient care must demonstrate competencies specific to the population served.
Bachelor's Degree in Health Information Technology, business Administration, or related field and 2-3 years of experience in coding/patient accounting; OR an equivalent combination of education and experience
Experience with insurance, managed care, and denials management preferred
AHIMA or AAPC coding credentials required (CCA, CCS, CCS-P, CPC, CPC-H, RHIT or RHIA) or obtained within 6 months of hire.
• Knowledge of the operations of patient billing and payer grievance procedures
• Demonstrated knowledge of insurance plans (i.e., commercial, Medicare, HMO/PPOs, etc.)
• Demonstrated coding knowledge - CPT and preferably both code sets ( ICD9 and ICD10)
• Proficient in Epic - ability to utilize multiple work queues and understand workflow and processes
• Excellent oral and written communication skills
• Working knowledge of managed care principles and regulatory requirements
• Demonstrates excellence in the areas of leadership, teamwork, customer services, quality, and contributes to the organizations financial success
• Demonstrates the ability to coordinate multiple functions
• Ability to utilize word processing, excel spreadsheets, presentation programs, and other software relevant to the job
• Communicates with internal customers such as, physician offices, multi-disciplinary team, finance, and management
• Communicates effectively with external customers such as, patients, third party payers, insurance representatives, community agencies on a daily basis and often simultaneously
• Regularly utilizes effective negotiation and conflict resolution skills as needed
• Daily and on-going communication with all members of the revenue cycle
• Ability to interact and communicate with multiple departments and physicians
Work which produces levels of mental/visual fatigue which are typical of jobs that perform a wide variety of duties with frequent and significant uncontrollable deadlines. Work may include the operation of and full attention to a personal computer or CRT up to 40 percent of the time.
The job produces some physical demands. Typical of jobs that include regular walking, standing, stooping, bending, sitting, and some lifting of light weight objects.
• Identification of charging issues (duplicates, overcharges, etc) and communicate with departments to resolve the issues.
• Resolve commercial payor denials after billing (no authorization, not covered, and partial payments).
• Charge entry and invoice reconciliation for Fresenius and Davita.
• Perform bedside procedure pricing for HIM.
• Identify errors/problems with Event Management (registration), accommodation codes and report to appropriate areas for any necessary corrections.
• Participate in corporate, payor, and governmental audits, reviews, and appeal activities.
• Identification and communication of denial trends, operational issues, and payor changes.
• Daily and ongoing communication daily with patient accounting, insurance representatives, and physician offices.
• Maintains awareness of trends in healthcare, reimbursement methodologies and utilization management specialty area by participating in professional organizations, seminars, and educational programs.
• Manage audit dashboard (reporting, building, maintaining).
• Resource for verification and physician offices on denials due to coverage changes - collaborate to resolve.
Shift
First Shift
Time Type
Full time
Scheduled Weekly Hours
40
Cost Center
1225 Revenue Integrity (BHG)
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