Denials Analyst

Responsibilities

• Research and resolve claim denials, ADR requests, and certifications
• Submit and track appeals to facilitate revenue recovery
• Identify patterns, trends, and root causes for denials and report findings to management
• Maintain a library of payer reference material regarding pre-authorization and medical necessity
• Perform in-depth account research to understand all aspects of claims billing
• Contact payers via phone, websites, and correspondence to perform timely follow-up
• Perform manual calculations of expected reimbursement to validate contract adherence
• Generate reports in Epic and other relevant software as requested
• Collaborate with Revenue Cycle stakeholders to provide information for process improvement

Requirements

• High school diploma, GED, or higher level degree
• 3 years of hospital or professional billing experience
• Proven experience in denied claims follow-up and appeals processing
• Knowledge of CPT, HCPCS, and ICD-10 coding requirements
• Proficiency in Microsoft Office Suite (Word, Excel, Outlook, PowerPoint)
• Strong analytical skills and attention to detail

Preferred Qualifications

• Associate's degree
• Certified coder or current enrollment in a coding program
• Experience in patient accounting within a high-volume claims environment
• Knowledge of CMS coverage requirements and Medicare/Medi-Cal reimbursement methodologies

About the Company

Eisenhower Health has been a leader in health care for the Coachella Valley since 1971. We continue to grow our services, capabilities, and facilities to meet the needs of our expanding community, delivering state-of-the-art care through our medical center and beyond.