Job description

Overview

The Enterprise Denial Analyst is responsible for reviewing technical denial claims, submitting reconsiderations or appeals. Reporting to the Enterprise Technical Denial Assistant Manager this role is responsible to optimize the financial outcomes of the hospital-based revenue cycle through maintaining a low denial rate and high reimbursement rate at an enterprise level for UF Health. Initiates a root cause analysis of denied payment through comprehensive means including but not limited to: research of patient stays and treatment, review of payer contracts, analysis of historical denials, appeals and their outcomes, emerging trends in payer practices and requirements. Works to maintain third-party payer relationships, including responding to inquiries, complaints and other correspondence. Working in conjunction with the Enterprise Technical Denial Assistance Manager and Enterprise Sr Denial Manager, maintains a strong working relationship with the Enterprise Managed Care Department to escalate and resolve atypical denial issues. Knowledgeable of state/federal laws that relate to contracts and to the appeals process.

The enterprise denial analyst is considered a technical denial expert in denial management and ensures all denied claims are accurately worked from a technical/ billing perspective. Working in collaboration with the different revenue cycle departments through the enterprise to establish best practice solutions to maximize reimbursement and minimize organizational write-offs.

Qualifications

Minimum Education and Experience Requirements:

Education & Experience:

High school graduate required and four (4) years coding or billing, insurance follow up, collections or denial management in a hospital /clinical setting.
Prefer Associate
s degree or higher in a health or business-related field and 3 years coding or billing, insurance follow up, collections or denial management in a hospital /clinical setting.

Knowledge, Skills, Abilities:

Demonstrated knowledge of:
Hospital billing and reimbursement
Denials and appeals
Third-party contracts
Federal and state regulations governing the healthcare industry
Excellent critical thinking and analytical skills
Attention to detail and ability to complete the job with minimal errors and work independently.
Proficient organizational skills
Excellent writing and communication skills
Ability to prioritize and manage time effectively.
Proficient in Microsoft Office Products such as Outlook, Word, Excel
Knowledge of HIPPA guidelines
Ability to read and interpret EOB
s.
Strong research and problem-solving skills
High level of comfort with computer systems

Motor Vehicle Operator Designation:

Employees in this position:

Will not operate vehicles for an assigned business purpose

Licensure/Certification/Registration:

None

Required profile