Job description

Job Overview Under the direct supervision of the Manager of Revenue Cycle Operations, the Claims Analyst is responsible for the day-to-day activities and resolution of assigned medical claims including denied, unpaid and underpaid accounts. The Certified Denial Recovery Specialist will utilize intermediate skills in denial analysis and resolution of all assigned patient accounts based on contractual obligations. Job Duties • Proactively reviewing and researching all accounts assigned and completing all necessary activity to resolve the claim. This includes: • Bill correction and resubmission. • Generation of appeal letters. • Written and oral correspondence with payers. • Calculating adjustments and forwarding appropriate requests to client. • Responding to documentation requests from payers. • Transfer of balance to patient liability or appropriate financial class as determined by review and research. • Researching client data systems to determine current status, history and past actions on claim. • Determining appropriate action to resolve denial. • Investigating and/or ensuring that questions and requests for information are responded to in a timely and professional manner resulting in accurate resolution of assigned accounts. • Perform ongoing monitoring of accounts worked to ensure maximization of collection dollars through appropriate follow-up and documentation of actions taken in client and/or HBS computer systems as appropriate. • Review remittance advices for denials and trends for the payers assigned. Referring all payer issues/problems to Leadership in a timely manner, making recommendations to the Project Director/Revenue Cycle Director for resolution and elimination of denials where possible. • Researching, reviewing, and adhering to all federal, state, and local regulatory collection guidelines, as well as payer specific billing/collection guidelines. • Provide customer service, including timely response to telephone calls, e-mails, and other verbal or written correspondence. Resolve client complaints to satisfaction. • Participate in special projects or other responsibilities as needed or assigned. • Carries out the mission, vision, values, and quality commitment of HBS. • Practice HIPAA compliance. • Attend staff and other professional meetings, including technical or professional classes, workshops, or seminars, to exchange information and improve technical or professional skills. Job Requirements • High School Degree required / College degree strongly preferred. • 2 years prior experience in dealing with relevant revenue cycle operations from a vendor or hospital financial offices, including familiarity with major payors. Preference given to candidates with experience in Florida markets. • Good verbal / written communication skills • Ability to use a computer, facsimile and copy machine. • Intermediate Microsoft Office skills (Excel, Word, Outlook).

Requirements