Denials Analyst / Utilization Review / Full Time at Catawba

Hickory, North Carolina, United States -

Full Time

Start Date

Immediate

Expiry Date

05 May, 26

Salary

0.0

Posted On

04 Feb, 26

Experience

0 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Analytical Skills, Billing Regulations, Claim Form Requirements, Healthcare Reimbursement, Microsoft Excel, Data Analysis, Problem-Solving, Critical Thinking, Communication Skills, Customer Service Skills

Industry

Hospitals and Health Care

Description

Summary of Performance Expectations: Position is responsible for working with various internal and external customers regarding review, research, and resolution of denied claims. This position will review accounts and take appropriate actions based on type of denial and department procedure and will be responsible for reprocessing claims, submitting appeals, and performing claim adjustments. Strong analytical skills needed to analyze denial and adjustment trends. Proficient knowledge of billing regulations, claim form requirements, and processes for payer sources, government, and non-government. Must work within contract language and have an understanding of healthcare reimbursement methodologies and language. Majority of time will be spent working within Meditech, payer websites, RCW, Microsoft Excel, performing data analysis, tracking, trending, and research. Education & Credentials: Required Associates degree or relevant experience in utilization review or finance/revenue cycle, working denials, managed care contracting, or payor relations. Must possess a strong understanding of revenue cycle and managed care operations. Strong to advanced Microsoft Excel and analytical skills required. Intermediate level of Microsoft Word and PowerPoint. Preferred Work Experience: Required One year of applicable experience, if candidate has no experience, they must have completed a successful healthcare internship in Utilization Review and/or finance, revenue cycle, medical billing, or denial management. with good references or an extensive managed care or an analytical background. Knowledge of healthcare reimbursement with a familiarity of CPT codes, DRGs, ICD-9s, & billing methodology for hospitals and physician practices. An understanding of managed care contracts and experience in working denials and appeals is helpful. Demonstrated experience in problem-solving, critical thinking, accomplishing tasks on assigned timelines, and evidence of sound judgement. Excellent PC, Excel skills and ability to learn and use new software applications is important. Excellent communication and customer service skills. Given experience and on-the job training, incumbent should be proficient in the basic aspects of the position in three months of employment date. Preferred About Catawba Valley Medical Center COMPREHENSIVE, ACCESSIBLE HEALTHCARE SERVICES IN THE CATAWBA VALLEY As the region’s largest not-for-profit community hospital, we exist to heal and comfort patients, to promote and foster a healthier community, and to ensure access to healthcare to all who need it - regardless of ability to pay. With a wide array of medical specialties, our skilled nurses and providers are trained to treat virtually any type of injury or illness, providing high-quality, easily accessible healthcare close to home. Our mission: Exceptional Healthcare. Every Person. Every Time. At A Glance: North Carolina’s first and only 5-time Magnet recipient for nursing excellence Region’s only level III Neonatal Intensive Care Unit (NICU) Women’s Choice Award winner for America’s Best 100 Hospitals for Patient Experience for six consecutive years American College of Surgeons Accredited Comprehensive Community Cancer Center HIGH LEVEL OF TECHNICAL CARE FROM MEDICAL EXPERTS Catawba Valley Medical Center offers a wide range of services from experienced medical specialists capable of addressing virtually any healthcare concern. Our current hospital holds 258 beds and serves the five-county Hickory area. Through our skilled medical practitioners and our highly trained staff, we strive to provide the highest level of medical expertise using the latest, state-of-the-art technology available. One of our goals at Catawba Valley Medica Center is to provide seamless care between your primary care provider and our hospital. Being a part of a vast healthcare network allows for easier and more efficient communication between local physicians, medical specialists and our hospital. No one should have to travel far for the expert level medical treatment they need. We work with a plethora of medical specialists capable of diagnosing, treating and operating on a wide variety of conditions.

Responsibilities

The Denials Analyst is responsible for reviewing, researching, and resolving denied claims while taking appropriate actions based on denial types and department procedures. This includes reprocessing claims, submitting appeals, and performing claim adjustments.