USA Health

Compensation

Full Description

Overview: USA Health is Transforming Medicine along the Gulf Coast to care for the unique needs of our community. USA Health is changing how medical care, education and research impact the health of people who live in Mobile and the surrounding area. Our team of doctors, advanced care providers, nurses, therapists and researchers provide the region's most advanced medicine at multiple facilities, campuses, clinics and classrooms. We offer patients convenient access to innovative treatments and advancements that improve the health and overall wellbeing of our community. Responsibilities: The denial analyst is responsible for reviewing technical denial claims, finding denial root cause, and helping to create action plans for overall system denial prevention; reporting to the Revenue Integrity Director, this role is responsible for optimizing the financial outcomes of the hospital-based revenue cycle through maintaining a low denial rate and high reimbursement rate at an enterprise level for USA Health; initiates a root cause analysis of denied payment through comprehensive means, including, but not limited to, research of patient stays and treatments, review of payer contracts, analysis of historical denials, appeals and their outcomes, emerging trends in payer practices and requirements; works closely with the managed care department to maintain third-party payer relationships, including responding to inquiries, complaints and other correspondence; working with the clinical nurse reviewers, charge analysts and revenue integrity analysts to identify gaps in the clinical and financial workflows; coordinates work efforts to fill and correct gaps for denial mitigation; maintains a strong working relationship with the enterprise managed care department to escalate and resolve atypical denial issues; maintains a strong working relationship with clinical and financial leaders throughout the organization to facilitate ownership and improvement; demonstrated knowledge of: hospital billing and reimbursement, denials and appeals, and federal and state regulations governing the health care industry; excellent critical thinking and analytical skills; attention to detail and ability to complete the job with minimal errors and to work independently; proficient organizational skills; excellent writing and communication skills; ability to prioritize and manage time effectively; proficient in Microsoft Office products such as Outlook, Word and Excel; knowledge of HIPPA guidelines; regular and prompt attendance; ability to work schedule as defined and overtime as required; related duties as required. Qualifications: Associates degree in a related field from an accredited institution as approved and accepted by the University of South Alabama and four years of coding collections or denial management experience in a hospital/clinical setting. Experience with Cerner Millennium required.