Denials Analyst

Job Title: Denials Analyst

Job Type: Full Time

Pay Range: $26 -$32 per hour

Schedule: Monday through Friday

Role Description: The Denials Analyst is responsible for reviewing and analysing denied insurance claims to determine the reasons for denial, resolving the issues, and ensuring the payment of claims in compliance with company policies and insurance requirements. This role involves working closely with healthcare providers, insurance companies, and other departments to facilitate the appeals process, and to reduce the frequency of claim denials.

Roles & Responsibilities

* Uphold a strong commitment to business ethics, including confidentiality and data privacy.

* Maintain consistent performance to achieve predefined performance metrics.

* Strictly adhere to compliance regulations and security policies.

* Ensure compliance with all federal, state and local laws.

Expected/Key Results

Review and Analyze Denied Claims:

* Investigate reasons for denials or partial payments by analyzing insurance claims.

* Review payer correspondence to identify denial codes and determine necessary follow-up actions.

Identify and Address Root Causes:

* Evaluate and identify trends in denials (e.g., incorrect coding, missing documentation,

or eligibility issues).

* Work with relevant departments (coding, billing, clinical, etc.) to ensure proper claim submissions and prevent future denials.

* Strong communication skills (both verbal and written) needed to effectively communicate trends, root cause and action plans.

Appeals Management:

* Prepare and submit appeals for denied claims, including gathering necessary documentation and supporting evidence.

* Track and follow up on the status of appeal submissions to ensure timely resolutions.

* Communicate with insurance companies to facilitate the appeal process.

Collaboration:

* Coordinate with insurance companies, internal billing teams, and medical providers to resolve payment issues.

* Assist other departments in understanding denial trends and implementing corrective actions.

Data Management and Reporting:

* Maintain accurate records of denied claims, appeal outcomes, and resolutions.

* Prepare and present regular reports on denial trends, resolution statistics, and financial impact.

* Recommend process improvements based on data analysis to minimize future claim denials.

Customer Service:

* Respond to inquiries from clients or other stakeholders regarding denied claims.

* Provide timely updates on the status of claims and appeals.

Compliance and Industry Knowledge:

* Stay updated on changes in healthcare regulations, payer policies, and insurance requirements.

* Ensure compliance with industry standards and regulations when addressing denied claims and appeals.

Qualifications

The qualifications listed below are representative of the background, knowledge, skill, and/or ability required to perform their duties and responsibilities satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the job.

Education:

* High school diploma or equivalent required; a degree in healthcare administration, business, or related field is preferred.

Work Experience:

* Previous experience in medical billing, coding, or healthcare claims processing is required (typically 2-3 years).

* Experience in handling denials and insurance appeals. Competencies & Skills

* Strong analytical and problem-solving skills.

* Excellent written and verbal communication skills.

* Attention to detail and accuracy.

* Ability to work under pressure and meet deadlines.

* Familiarity with medical terminology, insurance processes, and payer guidelines.

* Proficient in Microsoft Office (Excel, Word, etc.) and healthcare management software (e.g., Epic, Cerner, or others).

Additional Qualifications

* Ability to download 2-factor authentication application(s) on personal device, in accordance with company and/or client requirements

* Ability to pass a pre-employment background investigation based on client requirements, including but not limited to, criminal history, motor vehicle report, work authorization verification, credit report and drug test.

Work Environment:

* Full-time, office-based remote position

* Some positions may require occasional overtime or after-hours work to meet deadlines.

Physical Demands:

* Must be able to regularly or frequently talk and hear, sit for prolonged periods, use hands and fingers to type, and use close vision to view and read from a computer screen and/or electronic device.

Firstsource is an Equal Employment Opportunity employer. All employment decisions are based on valid job requirements, without regard to race, color, religion, sex (including pregnancy, gender identity and sexual orientation), national origin, age, disability, genetic information, veteran status, or any other characteristic protected under federal, state or local law.

Firstsource also takes Affirmative Action to ensure that protected veterans and qualified disabled persons are introduced into our workforce and considered for employment and advancement opportunities.