01Responsibilities
AR Management
Analyzing denied claims, identifying reasons for denials, and taking corrective actions to minimize future denials
Review medical codes and billing information for accuracy and compliance with billing guidelines to minimize claim rejections and denials
Ensure adherence to healthcare regulations and coding guidelines, including HIPAA and ICD-10 coding standards
Develop and implement strategies to address identified issues, including workflow changes, training programs, and system updates to enhance revenue cycle efficiency
Provide other Revenue Cycle Business Analysts and Specialists one-on-one training/cross training for reviewing and interpreting medical records and internal documentation to enhance appeal strategies
Make informed decisions based on knowledge of Payer policy and knowledge, state and federal guidelines and thorough review of internal documents including the translation of testing protocols and billing and how that impacts the adjudication of a claim to achieve a positive outcome
Payer Relations
Collaborate with payers, managed care, clinical and legal to resolve outstanding claims and address billing issues
Reporting
Analyze large volumes of revenue cycle data, including patient demographics, insurance verification, claim submissions, denial trends, and payment history to identify patterns and areas for improvement
Develop and maintain key performance indicators (KPIs) like days sales outstanding (DSO), denial rates, clean claim submission rates, and collection efficiency to track revenue cycle performance
Analyze and synthesize complex information to identify key issues, develop clear summaries, and define actionable next steps; collaborate across teams to ensure alignment, drive resolution, and maintain momentum on strategic initiatives
Successful Candidates Must Possess:
High school diploma or GED required; Degree in Business, Finance or related discipline preferred
With a high school diploma, a minimum of eight (8) years of experience in denials management and other areas of Healthcare Revenue Cycle Functions required; with a Bachelor's degree, a minimum of six (6) years of experience in denials management and other areas of Healthcare Revenue Cycle Functions required; with a Master's degree, a minimum of four (4) years of experience in years of experience in denials management and other areas of Healthcare Revenue Cycle Functions required
Experience using reporting tools and advanced excel skills required
Knowledge of insurance including Medicare, Medicaid, Blue Cross Blue Shield and Third-Party Payers required
Ability to utilize critical thinking skills while performing reimbursement/denial analysis
Aegis Sciences Corporation is an Equal Opportunity Employer
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Company : Aegis Sciences
Salary : Work from home
