Job Title

POSITION SUMMARY: The Denials Management & Reconciliation Analyst role involves processing of claims, posting electronic payments, claim adjustments, and review of non-coding related denials while working closely with patients, front desk staff and insurance carriers to ensure optimal submission and payment for all billable visits. This role requires expertise in healthcare billing, coding, electronic remittances and insurance policies to identify root causes of rejections, denials, appeal incorrect decisions, and implement strategies to minimize future denials. Works with software vendors and insurance companies to streamline and resolve issues identified throughout the claims process. Collaborates on performance improvement initiatives focused on coding, billing regulations, and coding standards such as ADA/CPT-4, HCPCS and ICD-10-CM. Coordinate with Medical Staff and coders for accurate charge capture and coding. Analyze clean claims rate, denials, days in AR, and recommend opportunities to the Director of Revenue Cycle. Investigates non-coding insurance denials and identifies and implements best-recommended action via feedback/reports to Director of Revenue Cycle Management. Understands and adheres to each insurance carrieru2019s claim submission guidelines. Makes necessary corrections to patient accounts for accurate electronic submission. Determines need for third party insurance payer appeal and sends individual appeal letters. Monitors appeals for resolution. Research, review and communicate with insurance carriers regarding open accounts receivable. Ensure compliance with company and regulatory standards. Prepare reports and presentations for quarterly departmental meetings. Assist with education and training for providers and front desk staff to ensure appropriate cash collection. Reports onsite for onboarding and orientation. Will consider hybrid schedule thereafter. EDUCATION & EXPERIENCE: Bacheloru2019s Degree in relevant field and 5-7 years of progressive, advancing, revenue cycle/medical billing experience or an equivalent combination of education, training, certification and progressive advanced experience in a healthcare setting, preferably in an Ambulatory Care, Outpatient facility operating in New York State. PHYSICAL REQUIREMENTS: While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle objects; controls, reach with hands and arms; climb stairs; balance; stoop; kneel; talk or hear; taste or smell. The employee must occasionally lift up to 15 pounds. Specific vision abilities required by the job include close vision, distance and color vision, peripheral vision, depth perception and the ability to adjust focus.