Insurance Reviewer and Denials Analyst - Patient Financial Services - FT Days (63167)

Job Summary:    Reviews and analyzes unpaid aging non-government claims, determining needed action to resolve unpaid claim.  Reviews, analyzes, and appeals (when appropriate) insurance payor denials.  Processes insurance payor refund requests regarding retroactive claim denials.  Duties include Anderson Hospital, Community Hospital of Staunton, Maryville Imaging, and Anderson Home Health accounts.

Job Responsibilities:

Reviews and analyzes unpaid aging non-government claims daily utilizing Meditech automated Tasks.

1. Determines current account status.
2. Follows up on payor websites or with payor customer service departments to determine payor status of claim adjudication.
3. Provides necessary action steps to expedite claim payment by payor.
4. Analyzes payor remittance advices to determine any needed action steps if partial payment is made by payor.
5. Determines of other insurance payors must be billed in the correct coordination of benefit order.
6. Escalates problem accounts to team or department leadership.
7. Notify Director of Patient Access of Registration errors via Commercial Collections Supervisor.
8. Notify Commercial Collections Supervisor of all other opportunities for improvement or reimbursement variance resolution.
9. Identify Opportunities for Process Improvement in Patient Financial Services or Patient Access.
10. Reviews, analyzes, and takes appropriate actions on payor refund request letters related denial issues.
11. Determines when to refund payors; authorize recoupments by payors; or appeal regarding disagreement with refund requests.
12. Reviews, analyzes, and takes appropriate actions regarding payor denials, utilizing Denials Management in Meditech.
13. Appeals denials whenever possible.
14. Reviews, analyzes, and takes appropriate actions with other insurance correspondence received.
15. Communicates regarding issues with Commercial Manager and PFS Director.
16. Other duties as assigned, particularly as potential back-up for the Insurance Reviewer team and for Customer Service as needed.

Qualifications

Education Requirements and Other Requirements:

                Education Level:

                                High school diploma or equivalent. 

                Certification/Licensure:  N/A

                Experience Requirements:

                                5 years experience in hospital insurance follow-up and/or denials processing preferred.

                  5 years experience in hospital patient accounts experience preferred.

                                5 years experience in insurance follow-up and knowledge preferred.

                                Office procedures and keyboarding minimum 50 wpm preferred.

                                Microsoft Word and Excel experience preferred.

                                Other computer and organizational skills preferred.

                                Meditech experience helpful.