As the Denial Analyst, you will contribute to the Hospital’s mission by coordinating the analysis and effective resolution of denied claims with the purpose of reducing overall denials and increasing revenue. Responsible for interpreting payment and denial data, identifying payer and coding trends, risks, and opportunities, and implementing operational or systematic improvements. Collaborates with all three phases of the revenue cycle teams to communicate findings and work closely on process and system improvements. DUTIES AND RESPONSIBILITIES: + Responsible for prioritizing and managing to resolution denied claims with third party payers. + Research, develop and maintain a solid understanding of payer requirements, including filing limit, claim processing logic, coordination of benefits requirements, patient responsibility and authorization requirements. + Responsible for analyzing denials data, creating metrics, as well as tracking and trending denials and results. + Responsible for writing a timely, comprehensive, and compelling appeal to third party payers to get denials overturned. + Performs ongoing analysis to determine the root cause of denials and makes well-thought-out recommendations for workflow, operational or systemic changes. + Compiles, maintains and distributes reports to management on success of appeals and root cause analysis. + Serves as department resource related to denials and payer requirements and assists in education of staff in all areas of the revenue cycle. + Maintains a current working knowledge of healthcare related issues and regulations including but not limited to Medicare, Medicaid, Managed Care/Managed Medicaid, and Commercial payers. + Stays current with changes and upgrades to computer systems and applications. + Performs other related duties as assigned. EDUCATION AND RELATED EXPERIENCE: Required: + High School graduate or equivalent. + Advanced skills with Microsoft applications which may include Outlook, Word, Excel, PowerPoint and other web-based applications. + Candidate must possess a strong understanding of healthcare insurance eligibility and billing procedures. + Solid problem-solving and analytical skills that demonstrate resourcefulness and attention to detail. + Two years’ experience in a healthcare setting. Preferred: + Associates or Bachelor’s degree in business or related field. + Health Experience within hospital or professional billing setting. + Bilingual (English/Spanish). + Strong knowledge of medical terminology.