Denial Prevention Analyst

The Denial Prevention Analyst is responsible for claim denial prevention at Midland Memorial Hospital.  The analyst will collaborate with clinical teams, financial clearance, and insurance payers to verify all insurance/demographic information is accurate and that the authorization is complete and approved prior to discharge.  Will be responsible for completing retro authorizations if needed and appeals to secure reimbursement due will identify denial trends and work collaboratively with various departments to develop prevention measures.  Works to maintain third-party payer relationships, including responding to inquiries, complaints, and other correspondence.  Knowledgeable of state/federal laws that relate to contracts and to the appeals process.

SHIFT AND SCHEDULE

Monday – Friday: 8:00 AM – 5:00 PM

ESSENTIAL FUNCTIONS/PERFORMANCE EXPECTATIONS

• Performs quality improvement activities to ensure data integrity relative to denial reduction
• Tracks the status of denials and determines root cause
• Conducts internal and external correspondence accurately, clearly, concisely, and professionally while following organizational regulations
• Maintains data on the types of claims denied and root causes of denials, and collaborates with team members to make recommendations for improvements and resolving issues
• Prepares, maintains, assists with, and submits reports as required
• Regularly makes complex decisions within the scope of the position, and is comfortable working independently
• Document any and all applicable authorization information through detailed review of account to identify root cause of denial
• Identifies process improvement opportunities; develops, implements, monitors, and revises action plans.
• Work directly with case management on denial trends and strategies to appeal successfully.
• Works directly with Denial Coordinators on denial trends they are seeing and working together on prevention.

EDUCATION AND EXPERIENCE

• Education- High school diploma or equivalency required
• Demonstrated technical knowledge.
• Analytic skills and the confident ability to make quick, effective decisions under pressure
• Strong organizational and prioritization skills.
• Strong oral and written communication skills.
• Must have acceptable keyboard and 10-key skills, along with strong knowledge of Word, Excel, Access, and other general computer expertise, or an equivalent combination of education and experience.
• 5+ years medical billing office experience

PHYSICAL REQUIREMENTS

To perform this job successfully, an individual must be able to perform each essential responsibility satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The individual must be able to:

• Stand, walk, sit, stoop, reach, lift, see, speak and hear. Lifting is limited to 35 lbs. for clinical staff and to 50 lbs. for non-clinical staff. The individual must use an assisted-lift device or get another individual(s) to assist with the lift that is over these maximum limits.