Denials Analyst

In this crucial role, you will lead a team of denial specialists, driving the resolution of denied claims, identifying root causes, and implementing strategies to prevent future denials. Your dual expertise in denial management and Epic PB functionality will be critical in optimizing workflows, providing actionable insights, and ensuring maximum revenue capture for our clients.

Responsibilities:

Key Responsibilities:

• Identify, analyze, and trend common denial reasons (e.g., medical necessity, lack of authorization, coding errors, timely filing, incorrect modifiers).
• Develop and implement strategies to overturn denials and accelerate payment resolution.
• Act as a subject matter expert for Epic Resolute, specifically as it relates to denial prevention and resolution.
• Analyze Epic workflows and configurations to identify root causes of denials stemming from system setup or user error.
• Assist in troubleshooting Epic related issues that lead to denials.
• Develop and maintain denial management policies and procedures.
• Prepare and present regular reports on denial trends, recovery rates, and team performance to RCM leadership and clients.

Working hours: 8:00 AM - 5:00 PM

Skills:

see required

Education:

No Degree Required

Experience:

1-4 years

Qualifications:

Required Qualifications:

• 1+ years of direct, hands-on experience as an Epic Professional Billing (PB) Analyst or in a role heavily utilizing Epic PB for operational analysis and workflow optimization.
• Epic Resolute Certification is highly preferred. Additional Epic certifications (e.g., Prelude, Cadence) are a plus.
• Strong understanding of professional medical coding (CPT, ICD-10, HCPCS), claim submission (CMS-1500), and remittance processing (ERA/EOB).
• Exceptional analytical, problem-solving, and critical thinking skills.
• Excellent leadership, communication (verbal and written), and interpersonal skills.

-Proficient in Microsoft Excel (for data analysis and reporting).

Temp to hire in Hoover

Spherion has helped thousands of people just like you find work happiness! Our experienced staff will listen carefully to your employment needs and then work diligently to match your skills and qualifications to the right job and company. Whether you're looking for temporary, temp-to-perm or direct hire opportunities, no one works harder for you than Spherion.

Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.

At Spherion, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact Callcenter@spherion.com.

Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Spherion offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).

key responsibilities

Key Responsibilities:- Identify, analyze, and trend common denial reasons (e.g., medical necessity, lack of authorization, coding errors, timely filing, incorrect modifiers).- Develop and implement strategies to overturn denials and accelerate payment resolution.- Act as a subject matter expert for Epic Resolute, specifically as it relates to denial prevention and resolution.- Analyze Epic workflows and configurations to identify root causes of denials stemming from system setup or user error.- Assist in troubleshooting Epic related issues that lead to denials.- Develop and maintain denial management policies and procedures.- Prepare and present regular reports on denial trends, recovery rates, and team performance to RCM leadership and clients.

experience 1-4 years

skills see required

qualifications

Required Qualifications:- 1+ years of direct, hands-on experience as an Epic Professional Billing (PB) Analyst or in a role heavily utilizing Epic PB for operational analysis and workflow optimization.- Epic Resolute Certification is highly preferred. Additional Epic certifications (e.g., Prelude, Cadence) are a plus.- Strong understanding of professional medical coding (CPT, ICD-10, HCPCS), claim submission (CMS-1500), and remittance processing (ERA/EOB).- Exceptional analytical, problem-solving, and critical thinking skills.- Excellent leadership, communication (verbal and written), and interpersonal skills.-Proficient in Microsoft Excel (for data analysis and reporting).

education No Degree Required