University of California - San Francisco Campus and Health
Claims Denials Management & Resolution Analyst
University of California - San Francisco Campus and Health, San Francisco, California, United States, 94199
Overview
Claims Denials Management & Resolution Analyst Medical Group Business Services • Full Time 86084BR Job Summary
The Denials Management & Resolution Analyst, under the direction of their Manager and Associate Director, provides support in areas of revenue operations related to coding, auditing, denial management, and training for designated areas. Functions independently with a full understanding of all components of the revenue cycle to complete complex projects of diverse scope and/or portions of large projects. Responsibilities include claim edit and RFI resolution, managing Professional Billing claim denials by conducting a comprehensive review of clinical documentation. Write appeals based on clinical documentation, Letters of Agreement, and the medical policies of the payor, and submit the appeal promptly. Handle audit-related/compliance responsibilities and other administrative duties as required, including education and training to physicians and clinical staff on documentation to ensure compliance with coding guidelines. Perform an in-depth review of documentation and present findings with recommendations to the department on needed education. The position directly impacts hospital and physician reimbursement and is key to securing reimbursement and minimizing organizational write-offs. The incumbent should be familiar with all applicable billing and coding regulations and be able to effectively communicate these regulations to all levels of faculty, management, and staff. This position will also assign codes based on review of clinical charts, resolve coding issues based on denials, and identify areas of improvement. Salary/Benefits Note
The final salary and offer components are subject to additional approvals based on UC policy. Placement within the salary range is dependent on factors including work experience and internal equity within this position classification at UCSF. The annual salary range is $81,300-$172,300, with a target min. entry point of $97,680+ based on experience. For more about UCSF benefits, visit: https://ucnet.universityofcalifornia.edu/compensation-and-benefits/index.html Department Description
Medical Group Business Services (MGBS) is responsible for professional fee billing and collections for approximately 30 divisions in the School of Medicine. MGBS collects about $1B annually and focuses on ensuring charges are captured and increasing payments. Required Qualifications
Bachelor's degree in a related area or four years of equivalent experience/training. Two or more years of coding experience. Thorough knowledge of the healthcare revenue cycle and its components (billing, collections, charge capture, contractual adjustments, third-party reimbursements, cash management). Understanding of metrics, analytics, and tools used to measure and analyze the revenue cycle. Detail-oriented with strong time management, prioritization, and issue resolution abilities. Strong skills in report development, dashboard design, and software tools specific to healthcare revenue cycle management; proficiency with databases, spreadsheets, and presentations. Strong communication skills to interpret and convey complex clinical finance information; ability to prepare reports and presentations. Strong analytical and problem-solving skills; ability to evaluate workflows/systems and propose solutions. Strong interpersonal skills for collaboration on complex projects with diverse staff. Experience working with managers as a technical resource; ability to advise on regulatory changes and industry trends in revenue cycle management. Experience with CPT, ICD-10, E/M Documentation Guidelines (1995/1997), CCI edits, Medicare LCD/NCDs, and payor billing requirements. Knowledge of medical terminology, anatomy, and physiology. Preferred Qualifications
n/a License/Certification
Certified Professional Coder in good standing with AAPC, with yearly credits to maintain certification. About UCSF
At UCSF Health, our mission of innovative patient care, advanced technology, and pioneering research is redefining what’s possible for patients. UCSF Health is consistently ranked among the top hospitals and offers opportunities for professional growth in a collaborative environment. Pride Values
UCSF values PRIDE: professionalism, respect, integrity, diversity, and excellence. UCSF is committed to equity, diversity, and inclusive education, discovery, and patient care. Additional information at diversity.ucsf.edu. Join us to contribute to improving healthcare worldwide. Equal Employment Opportunity
The University of California is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age, protected veteran status, or other protected status under state or federal law. Organization/Location
Health • Emeryville, CA Campus: Emeryville Work Style: Flexible • Shift: Days • Shift Length: 8 Hours
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Claims Denials Management & Resolution Analyst Medical Group Business Services • Full Time 86084BR Job Summary
The Denials Management & Resolution Analyst, under the direction of their Manager and Associate Director, provides support in areas of revenue operations related to coding, auditing, denial management, and training for designated areas. Functions independently with a full understanding of all components of the revenue cycle to complete complex projects of diverse scope and/or portions of large projects. Responsibilities include claim edit and RFI resolution, managing Professional Billing claim denials by conducting a comprehensive review of clinical documentation. Write appeals based on clinical documentation, Letters of Agreement, and the medical policies of the payor, and submit the appeal promptly. Handle audit-related/compliance responsibilities and other administrative duties as required, including education and training to physicians and clinical staff on documentation to ensure compliance with coding guidelines. Perform an in-depth review of documentation and present findings with recommendations to the department on needed education. The position directly impacts hospital and physician reimbursement and is key to securing reimbursement and minimizing organizational write-offs. The incumbent should be familiar with all applicable billing and coding regulations and be able to effectively communicate these regulations to all levels of faculty, management, and staff. This position will also assign codes based on review of clinical charts, resolve coding issues based on denials, and identify areas of improvement. Salary/Benefits Note
The final salary and offer components are subject to additional approvals based on UC policy. Placement within the salary range is dependent on factors including work experience and internal equity within this position classification at UCSF. The annual salary range is $81,300-$172,300, with a target min. entry point of $97,680+ based on experience. For more about UCSF benefits, visit: https://ucnet.universityofcalifornia.edu/compensation-and-benefits/index.html Department Description
Medical Group Business Services (MGBS) is responsible for professional fee billing and collections for approximately 30 divisions in the School of Medicine. MGBS collects about $1B annually and focuses on ensuring charges are captured and increasing payments. Required Qualifications
Bachelor's degree in a related area or four years of equivalent experience/training. Two or more years of coding experience. Thorough knowledge of the healthcare revenue cycle and its components (billing, collections, charge capture, contractual adjustments, third-party reimbursements, cash management). Understanding of metrics, analytics, and tools used to measure and analyze the revenue cycle. Detail-oriented with strong time management, prioritization, and issue resolution abilities. Strong skills in report development, dashboard design, and software tools specific to healthcare revenue cycle management; proficiency with databases, spreadsheets, and presentations. Strong communication skills to interpret and convey complex clinical finance information; ability to prepare reports and presentations. Strong analytical and problem-solving skills; ability to evaluate workflows/systems and propose solutions. Strong interpersonal skills for collaboration on complex projects with diverse staff. Experience working with managers as a technical resource; ability to advise on regulatory changes and industry trends in revenue cycle management. Experience with CPT, ICD-10, E/M Documentation Guidelines (1995/1997), CCI edits, Medicare LCD/NCDs, and payor billing requirements. Knowledge of medical terminology, anatomy, and physiology. Preferred Qualifications
n/a License/Certification
Certified Professional Coder in good standing with AAPC, with yearly credits to maintain certification. About UCSF
At UCSF Health, our mission of innovative patient care, advanced technology, and pioneering research is redefining what’s possible for patients. UCSF Health is consistently ranked among the top hospitals and offers opportunities for professional growth in a collaborative environment. Pride Values
UCSF values PRIDE: professionalism, respect, integrity, diversity, and excellence. UCSF is committed to equity, diversity, and inclusive education, discovery, and patient care. Additional information at diversity.ucsf.edu. Join us to contribute to improving healthcare worldwide. Equal Employment Opportunity
The University of California is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age, protected veteran status, or other protected status under state or federal law. Organization/Location
Health • Emeryville, CA Campus: Emeryville Work Style: Flexible • Shift: Days • Shift Length: 8 Hours
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