Denials Analyst-Denials Analytics

Located in the heart of the Coachella Valley, you have access to resort-style living and world-class amenities throughout Southern California. Demonstrates compliance with Code of Conduct and compliance policies, and takes action to resolve compliance questions or concerns and report suspected violations. Manages denial inventory on a timely basis to promote payment and resolution of all accounts as instructed by management. Stays current on all payer requirements by reading bulletins, reviewing provider handbooks, accessing websites, etc. Participates and engages in training sessions to grow knowledge base pertaining to denials, revenue cycle, and/or payor trends. Contacts payors, performs timely follow-up through direct phone calls, provider claims websites, correspondence, appeals, etc. Performs manual calculations of expected reimbursement to validate payor adherence to contracts. Performs in-depth account research to understand every aspect of claims billing and resulting denial. Creates and submits strong, succinct appeals that result in revenue recovery for all types of denials including contract underpayments, payor error denials, etc. Identifies patterns, trends, and root causes for denials; reports findings to management to facilitate process improvement and resolution, including compilation of bulk denial issues across high volume of accounts. Generates and creates reports in Epic as requested. Adheres to HIPAA standards while performing denials research/resolution. Possesses knowledge of health care pricing and reimbursement methodologies, especially IPPS/OPPS. Understands health plan contracts, hospital revenue cycle functions, and payor compliance. Ability to identify denial issues and craft succinct payer appeal letters. Ability to prioritize and coordinate workflow productivity with attention to detail. Knowledge of LCDs, NCCI, MUE edits, Commercial, PPO, HMO, POS, EPO, and Medicare Advantage claims, authorization, and documentation requirements. Knowledge of CPT, HCPCS, and ICD-10 coding requirements with emphasis on modifiers and diagnosis associations. Proficient in Microsoft Office Suite (Word, Excel, Outlook, PowerPoint) and other relevant software applications. Strong analytical skills. Basic knowledge of CMS coverage requirements and types of Medicare coverage (Part A/Part B/Part C, etc.). Eisenhower Health offers a generous benefits package and a matched retirement plan.

Employees are eligible to participate in a benefits program designed to make a difference for you and your family. From the beginning, this organization formed a culture based on strong values, commitments, and a passion for service and professional excellence. What Our Nurses Say

One of my very favorite things about working at Eisenhower Health is the culture of inclusivity that we have and a strong base for evidence-based practice. Lori One of the greatest things about working as a nurse at Eisenhower Health is the support from Administration. We keep improving the process here. It's a fantastic place to work. My favorite thing about working at Eisenhower Health is the camaraderie within my unit and with different departments.

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