The Denials Analyst position reports to the Manager of Revenue Integrity. Responsible for immediate review of all denied claims, identification of the basis for filing an appeal, and/or resubmission of an accurate, compliant and timely claim and/or appeal letter resulting in reconsideration by the third party payer or upholding denial resulting in write-offs.
- High School graduate or equivalent
- Previous Collections or Insurance experience within last 3 years, preferred
- ICD9/CPT/Medical terminology preferred
- PC and Keyboarding Skills (30 WPM Preferred)
- Ability to work independently
- HRMA Credentialed Revenue Cycle Representative (within 2 years of hire)
- Two years hospital patient accounting experience, preferred
License or Certification Requirements:
- After 2015, HFMA Credentialed Revenue Cycle Representative required within 2 years of hire
Work Schedule: Days
Location: Hoover - Kankakee
- Daily review of denials identified by 835 files, manually posted R/As, EOBs, or Payer Correspondence in the Patient Accounting and/or Scanning system.
- Denial prevention - Identify denial trends; provide documentation, data and reporting to Senior Management and offer suggestions for process improvement to areas involved.
- Develop, implement and evaluate existing policies and procedures related to denials management.
- Identify and communicate system issues related to denials stemming from billing, edits, rejections and follow up work queues with the Epic Coordinators and Revenue Cycle Manager.
- Submit help tickets and work with Epic Application Coordinators and/or Analytics to resolve issues, including testing and training as necessary.
- Insure that all Clinical denials are assigned to the appropriate workflow and are written timely by the Utilization Review Staff.
- Maintain attendance at Managed Care In-services, onsite meetings and conference calls with Insurance Provider Representatives.
- Other duties as assigned.
- Provide training to peers assisting with denial management.
- Provides input as well as assisting with quality assurance process initiatives for Riverside Medical Center's Revenue Cycle as related to the improvement of the root cause of the denial.
- Responsible for submitting all Outpatient appeals denied due for Technical reasons.
- Responsible to maintain the Denial Management system and workflow.
- Working with the Application Analyst, the Denials Analyst will thoroughly test and document system upgrades and software modifications related to the Denial Management system.
- Timely follow up on all successfully submitted appeals, by use of work lists and queues, until a determination is made on the appeal.
To apply please email your resume to Email blocked - click to apply
Riverside Healthcare is revolutionizing care using leading-edge technology to diagnose and treat patients. We are ranked top in the nation for performance in neurosurgery, orthopedics, and heart surgery and have also been named one of the nation's 100 Top Hospitals® by Truven Health Analytics seven times. Riverside is nationally recognized for our specialty programs in obstetrics, trauma, oncology, rehabilitation, geriatrics, occupational health, psychiatric services, and treatment of alcohol and chemical dependency, as well as patient safety. We combine innovation and convenience at state-of-the-art facilities located in communities throughout the greater Kankakee area.
Riverside Medical Center proves that truly progressive medicine is being delivered in Chicago’s southwest suburbs and East Central Illinois. Join a team that is not only concerned with providing the best care possible but also with offering a work environment of advancement and growth. Riverside is a place that embraces a culture where opinions count and dedication is respected, where superior performance is rewarded with competitive salaries and excellent benefits.