Denials Management Analyst I

Company: Driscoll Children's Hospital
Location: Corpus Christi
Posted on: November 13, 2024

Job Description:

Denials Management Analyst I
Locations: Corpus Christi, TX
Time Type: Full time
Posted on: Posted 2 Days Ago
Where compassion meets innovation and technology and our employees are family.
Thank you for your interest in joining our team! Please review the job information below.
General Purpose of Job:
Under direct supervision, the Denial Management Analyst will assist with the Billing, Follow-Up, Collection, Root Causing, Recovery, and Reporting of assigned Insurance or Self-Pay claims. Applying a scientific approach, including research and analysis, the Denials Management Analyst will assist with the discovery of denials or denial trends and offer recommendations for solutions as a denial preventive. Additionally, the Denial Management Analyst will serve as a liaison between entities, promoting opportunities for inclusion and awareness through communication to stakeholders as denials or denial trends are discovered.
Essential Duties and Responsibilities:

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• Maintains utmost level of confidentiality at all times.
  
• Adheres to hospital policies and procedures.
  
• Demonstrates business practices and personal actions that are ethical and adhere to corporate compliance and integrity guidelines.
  
• Assist with the Billing, Follow-Up, Collection, Root Causing, Recovery, and Reporting of assigned Insurance or Self-Pay claims.
  
• Familiarity and adherence to payer timely filing, corrected claim, and appeal deadlines, and apply to assigned claims as necessary.
  
• Familiarity and adherence to payer reimbursement policies and apply to assigned claims as necessary.
  
• Familiarity and adherence to payer clinical policies and apply to assigned claims as necessary.
  
• Familiarity and adherence to Health System contractual agreement(s) and apply to assigned claims as necessary.
  
• Familiarity and adherence to Texas Administrative Code(s), or Bylaws, and apply to assigned claims as necessary.
  
• Root cause claim denials and offer recommendation for prevention.
  
• File appeals as appropriate to resolve payer denials and work with payers to monitor appeals in process.
  
• Document efforts, conversations as correspondences with clarity and comprehension, within the Electronic Medical Record System.
  
• Track and trend denials and recovery efforts by utilizing various departmental tools and appropriately reporting ongoing problems specific to payers, health system departments, and/or contracts.
  
• Collaborate with clinical personnel as needed to appeal and resolve assigned claims.
  
• Ability to communicate effectively with all stakeholders across the health system, furthermore, disseminate denial efforts to key stakeholders as appropriate.
  
• Maintain a comprehensive payor and managed care intelligence database to source research and analysis as needed.
  
• Recommends appeal templates for denial trends, as appropriate.
  
• Evaluates opportunities and financial terms for the health system.
  
• Assist with the strategic and financial judgment necessary to achieve profitable growth with payors.
  
• Supports and participates in the continuous assessment and improvement of the quality of care and services provided.
  
• Assist departmental leadership in resolving managed care operational issues and provide interpretation of managed care contract language, terms, and conditions.
  
• Consistently meet the current productivity standards in addressing and resolving denied accounts.
  
• Consistently meet the current quality standards in taking appropriate actions to identify and track root causes, successfully appeal denied accounts, and trend issues.
  
• Gather, verify, and evaluate confidential and sensitive organizational information, consistent with assigned claims.
  
• Provide individual contribution to the overall team effort of achieving departmental goals.
  
• Demonstrate proficient use of systems and execution of processes in all areas of responsibilities.
  
• Maintains a sense of professional and self-validation.
  
• Assure patient privacy and confidentiality as appropriate or required.
  
• Maintain professional relationships and convey relevant information to other members of the healthcare team, within the facility and any applicable referral agencies.
  
• Assist with special projects as assigned.
  
• Other duties as assigned.
  
  EDUCATION AND/OR EXPERIENCE:
  Bachelor's degree (B. A.) from four-year college or university; or one to two years related experience and/or training; or equivalent combination of education and experience.
  Minimum of one year healthcare experience in a healthcare setting. Outstanding analytical ability and financial skills. Working knowledge of managed care operations and practices preferred. Working knowledge of health system admitting, billing, and utilization review as well as physician office practices, physician credentialing and physician billing practices preferred. Effective communication, organization, and interpersonal skills essential. Work independently. Excellent oral and written communication skills. PC skills necessary with experience in Microsoft Office products, including PowerPoint.
  About Us
  Until all children are well.
  Driscoll Children's Hospital and its specialty centers, urgent care centers, and after-hours facility serve a vast area covering 31 South Texas counties. The hospital is a 191-bed tertiary care center offering 32 medical and 13 surgical specialties. Combined with our non-profit, community-based Health Plan, Driscoll Health System is an exceptional workplace for anyone with a big heart and a drive for success.
  Smiles, hugs, and a soothing touch are as much a part of Driscoll's approach to treating children as is its advanced medical treatments and technologies. The core values at Driscoll Health System are: Compassion, Advocacy, Respect, Excellence, and Stewardship. These values are exemplified through every position - from treating the most critical patients hands-on, to maintaining a clean environment, to keeping the organization running from behind the scenes.
  We invite you to learn about Driscoll's rich history and explore the laidback lifestyle South Texas has to offer.
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Keywords: Driscoll Children's Hospital, Corpus Christi , Denials Management Analyst I, Executive , Corpus Christi, Texas