Riverside Healthcare
Overview
The Denials Analyst I is responsible for analyzing, managing, and resolving denied claims at Riverside Healthcare. This role involves reviewing denied claims related to small level medical necessity denials to identify root causes and appeal said denials. The Denials Analyst works closely with billing, coding, and revenue cycle teams to ensure accurate and timely claim resolution.
Essential Job Duties Review and analyze denied claims to determine the reason for denial and potential for resolution. Collaborate with billing and coding teams to gather necessary documentation and information for appeals. Monitor and track the status of denied claims and appeals, ensuring timely follow-up and resolution. Assist in maintaining detailed records of denial trends, appeal outcomes, and related activities for reporting and analysis. Stay informed about basic changes in payer policies, coding guidelines, and industry regulations that may impact claim denials and resolution. Work small level medical necessity denials specific to laboratory and radiology. Proficiently pull and send in medical records for payer audit requests. Average productivity of around 80 accounts a week. Develop and submit appeal letters to insurance companies, utilizing accurate data and thorough explanations to support claim adjustments. Nonessential Tasks
Continuously update knowledge on industry standards and best practices. Responsibilities
Preferred Education/Licensure
Associates degree in Healthcare Administration, Business, Finance, or a related field preferred. Required Education/Licensure
None Preferred Experience
None Required Experience
0-2 years of experience in claims management, denial analysis, or revenue cycle operations within a healthcare setting. Basic knowledge of payer policies, medical coding (ICD-10, CPT, HCPCs), and healthcare reimbursement processes. Strong communication skills, both written and verbal, with the ability to interact effectively with insurance companies and internal teams. Ability to work under supervision, prioritize tasks, and manage time effectively. Employee Health Requirements
Exposure to:
Chemicals: None Video Display Terminals: Extreme Blood and Body Fluids: None TB or Airborne Pathogens: None Sensory requirements (speech, vision, smell, hearing, touch):
Speech: Needed for presentations/training, telephone communication, facilitate meetings. Vision: Needed to read memos and literature. Smell: N/A Hearing: Needed for telephone communications, meetings, and listening to employee concerns. Touch: Need to write, do computer entry, filing. Activity/Lifting Requirements
Percentage of time during the normal workday the employee is required to:
Sit: 85% Twist: 0% Stand: 5% Crawl: 0% Walk: 5% Kneel: 0% Lift: 2% Drive: 0% Squat: 1% Climb: 0% Bend: 1% Reach above shoulders: 1% The weight required to be lifted each normal workday according to the continuum described below:
Up to 10 lbs: Occasionally Up to 20 lbs: Occasionally Up to 35 lbs: Not Required Up to 50 lbs: Not Required Up to 75 lbs: Not Required Up to 100 lbs: Not Required Over 100 lbs: Not Required Describe and explain the lifting and carrying requirements. (Example: the distance material is carried; how high material is lifted, etc.): Lifting is not usually required.
Maximum consecutive time (minutes) during the normal workday for each activity:
Sit: 408 Twist: 0 Stand: 24 Crawl: 0 Walk: 24 Kneel:0 Lift: 9 Drive: 0 Squat: 8 Climb: 0 Bend: 8 Reach above shoulders: 4 Repetitive use of hands (Frequency indicated):
Simple grasp up to 10 lbs. Normal weight: 5- 10lbs frequent Pushing & pulling Normal weight Fine Manipulation: Terminal entry, calculator. Repetitive use of foot or feet in operating machine control: None
Environmental Factors & Special Hazards
Environmental Factors (Time Spent): Inside hours: 40 Outside hours : 0 Temperature: Normal Range Lighting: Average Noise levels: Average Humidity: Normal Range Atmosphere: Dust &Poor Ventilation
Special Hazards:
Protective Clothing Required: None
Pay Range
USD $21.92 - USD $26.85 //Hr
The Denials Analyst I is responsible for analyzing, managing, and resolving denied claims at Riverside Healthcare. This role involves reviewing denied claims related to small level medical necessity denials to identify root causes and appeal said denials. The Denials Analyst works closely with billing, coding, and revenue cycle teams to ensure accurate and timely claim resolution.
Essential Job Duties Review and analyze denied claims to determine the reason for denial and potential for resolution. Collaborate with billing and coding teams to gather necessary documentation and information for appeals. Monitor and track the status of denied claims and appeals, ensuring timely follow-up and resolution. Assist in maintaining detailed records of denial trends, appeal outcomes, and related activities for reporting and analysis. Stay informed about basic changes in payer policies, coding guidelines, and industry regulations that may impact claim denials and resolution. Work small level medical necessity denials specific to laboratory and radiology. Proficiently pull and send in medical records for payer audit requests. Average productivity of around 80 accounts a week. Develop and submit appeal letters to insurance companies, utilizing accurate data and thorough explanations to support claim adjustments. Nonessential Tasks
Continuously update knowledge on industry standards and best practices. Responsibilities
Preferred Education/Licensure
Associates degree in Healthcare Administration, Business, Finance, or a related field preferred. Required Education/Licensure
None Preferred Experience
None Required Experience
0-2 years of experience in claims management, denial analysis, or revenue cycle operations within a healthcare setting. Basic knowledge of payer policies, medical coding (ICD-10, CPT, HCPCs), and healthcare reimbursement processes. Strong communication skills, both written and verbal, with the ability to interact effectively with insurance companies and internal teams. Ability to work under supervision, prioritize tasks, and manage time effectively. Employee Health Requirements
Exposure to:
Chemicals: None Video Display Terminals: Extreme Blood and Body Fluids: None TB or Airborne Pathogens: None Sensory requirements (speech, vision, smell, hearing, touch):
Speech: Needed for presentations/training, telephone communication, facilitate meetings. Vision: Needed to read memos and literature. Smell: N/A Hearing: Needed for telephone communications, meetings, and listening to employee concerns. Touch: Need to write, do computer entry, filing. Activity/Lifting Requirements
Percentage of time during the normal workday the employee is required to:
Sit: 85% Twist: 0% Stand: 5% Crawl: 0% Walk: 5% Kneel: 0% Lift: 2% Drive: 0% Squat: 1% Climb: 0% Bend: 1% Reach above shoulders: 1% The weight required to be lifted each normal workday according to the continuum described below:
Up to 10 lbs: Occasionally Up to 20 lbs: Occasionally Up to 35 lbs: Not Required Up to 50 lbs: Not Required Up to 75 lbs: Not Required Up to 100 lbs: Not Required Over 100 lbs: Not Required Describe and explain the lifting and carrying requirements. (Example: the distance material is carried; how high material is lifted, etc.): Lifting is not usually required.
Maximum consecutive time (minutes) during the normal workday for each activity:
Sit: 408 Twist: 0 Stand: 24 Crawl: 0 Walk: 24 Kneel:0 Lift: 9 Drive: 0 Squat: 8 Climb: 0 Bend: 8 Reach above shoulders: 4 Repetitive use of hands (Frequency indicated):
Simple grasp up to 10 lbs. Normal weight: 5- 10lbs frequent Pushing & pulling Normal weight Fine Manipulation: Terminal entry, calculator. Repetitive use of foot or feet in operating machine control: None
Environmental Factors & Special Hazards
Environmental Factors (Time Spent): Inside hours: 40 Outside hours : 0 Temperature: Normal Range Lighting: Average Noise levels: Average Humidity: Normal Range Atmosphere: Dust &Poor Ventilation
Special Hazards:
Protective Clothing Required: None
Pay Range
USD $21.92 - USD $26.85 //Hr