Insurance Reviewer AND Denials Analyst - Patient Financial Services - FT DAYS

Commercial Claims Analyst

Job Summary: Reviews and analyzes unpaid aging commercial claims for the necessary action needed to resolve accounts. Reviews, analyzes, and appeals (when appropriate) insurance payor denials. Processes insurance payor refund requests regarding retroactive claim denials. Duties include all of Anderson Healthcare's acute facilities. Possibility of hybrid remote work after completion of 90 day training period. If eligible for hybrid remote work; requirements would be 1 full day once a week in the office.

Job Responsibilities:

• Reviews and analyzes unpaid aging commercial claims daily utilizing Meditech automated Tasks.
• Determines current account status.
• Follows up on payor websites/portals or with payor customer service departments to determine payor status of claim adjudication.
• Provides necessary action steps to expedite claim payment by payor.
• Analyzes payor remittance advices to determine any needed action steps if partial payment is made by payor.
• Determines if other insurance payors must be billed in the correct coordination of benefit order.
• Escalates problem accounts to team or department leadership.
• Notify Patient Access Leadership of Registration errors along with Commercial Insurance Manager.
• Notify Commercial Insurance Manager of all other opportunities for improvement or reimbursement variance resolution.
• Identify Opportunities for Process Improvement in Patient Financial Services.
• Reviews, analyzes, and takes appropriate actions on payor refund request letters related denial issues.
• Determines when to refund payors; authorize recoupments by payors; or appeal regarding disagreement with refund requests.
• Reviews, analyzes, and takes appropriate actions regarding payor denials, utilizing Denials Management in Meditech.
• Appeals denials whenever possible.
• Reviews, analyzes, and takes appropriate actions with other insurance correspondence received.
• Communicates regarding issues with Commercial Manager and PFS Director.
• Follow up on tasks received for self pay patients through our third party vendor.
• Other duties as assigned, particularly as potential back-up for the Insurance Analysts Team, Accident/Work Comp Analyst, and Customer Service as needed.

Qualifications

Education Requirements and Other Requirements:

Education Level: High school diploma or equivalent.

Certification/Licensure: N/A

Experience Requirements: Minimum 2 years of experience with hospital insurance follow-up and/or denials processing required. Knowledgeable in hospital patient account receivables. Office procedures and keyboarding minimum 50 wpm preferred. Microsoft Word and Excel experience preferred. Experience with Microsoft Outlook preferred. Must be comfortable navigating insurance payer websites and/or portals. Ability to maintain professionalism and be respectful when calling insurance payers and/or patients. Other computer and organizational skills preferred. Commercial insurance billing knowledge is a plus. Meditech experience helpful.