Denials Analyst

Salary Range: $22.97 - $31.67

Pay rates are determined based on experience and internal equity.

Position Summary:

• Manage multiple projects including the denial process currently used at LVMC. Continually work to identify opportunities for workflow improvements.
• Collaborate with Director and Manager of Revenue Cycle to set goals, measure effectiveness and productivity, and identify the need for updated policies and/or procedures.
• Provide support to Revenue Cycle to ensure productivity and quality goals are met.
• Gather and assemble documentation related to monthly balancing, reports and research.
• Must work well under stress or tight deadlines.
• Must work well with supervisors, co-workers, patients/residents, family members and visitors.

District Responsibility:

• Support of the District Mission and Values
• Demonstrate respect, professionalism and courtesy to all patients, visitors, other providers and coworkers, as delineated in the LVMC “Commitment to Care”.
• Constantly use C-I-CARE principles when communicating with others.
• Performance Improvement Activities
• Professional Development

Position Duties/Responsibility:

• Knowledge of the appeals and denials processes for Medicare, Medi-Cal, and other private health insurance.
• Understanding of Insurance Billing and payments processing: EOBs, HCPCS, ICD10, CPT, and Medi-Cal crosswalk coding.
• Special projects with insurance denials, data entry and analysis.
• Education and implementation of new software system
• Must be extremely organized and possess excellent communication, interpersonal and problem-solving skills.
• Other Duties Assigned by Supervisor

Essential Functions:

• Work independently and also with a team.
• The ability to be supervised.
• The ability to work as a team member.
• Multi tasks and balance multiple projects.

Position Qualifications:

• Education: High School diploma or equivalent.
• Experience: Prefer 2+ years of experience working with commercial, Medicare, Medi-Cal and HMO insurance procedures. Working knowledge of full cycle billing and collection.
• Previous office/hospital experience preferred.
• Certifications: None necessary.
• Skills/Ability: Excellent verbal skills required. Exhibits the ability to organize multiple assignments and follow through with accuracy. Exercise is good judgment under stress. Demonstrates initiative, emotional stability, tact and poise.
• LVMC reserves the right to modify the minimum requirements depending on the needs of the organization.