Financial Clearance Denials Analyst

Salem Hospital
United States, Massachusetts, Salem
81 Highland Avenue (Show on map)
Feb 12, 2025
Summary The position researches, analyzes, and resolves claim denials for the hospital. The role also involves collaborating with insurance companies, central billing, case management, coding, and physician offices when necessary to verify claim information, level of care, accurate coding, and payer requirements to ensure financial reimbursement for services. Does this position require Patient Care? No Essential Functions -Perform all insurance verification for eligibility, coverage, and authorization requirements via Web or phone with third-party payers to obtain retroactive authorization for payment. -Contacts central billing, physician offices, and insurance companies to validate data, collect missing information, and resolve information discrepancies. Understands clinical guidelines for payors requiring authorization to build cases for retro authorization requests and claim denials appeals. -Work collaboratively with PHS Central Billing Office (CBO) to research, analyze, and resolve claim denials. -Identifies, monitors, and presents monthly denial performance accompanied with case studies and recommendations for process improvements. -Participates in external payer meetings, presenting payer performance related to denials. -Prepare, submit, and track appeals for denied claims, ensuring all necessary documentation, clinical information, and supporting evidence are included to justify payment. -Collaborate with the hospital's billing, coding, and clinical departments to obtain additional information or clarification needed for appeals. -Communicate with insurance companies and third-party payers to follow up on denied claims, resolve issues, and negotiate payment where applicable. -Maintain accurate records of all communications, appeals, resolutions, and denials and ensure compliance with payer requirements and hospital regulations. Education High School Diploma or Equivalent required and Associate's Degree Related Field of Study required Can this role accept experience in lieu of a degree? Yes Licenses and Credentials Experience Insurance, third-party payor, or secretarial experience in a healthcare setting 1-2 years required and Experience in denials management, appeals or related role 0-1 year preferred Knowledge, Skills and Abilities - Strong analytical skills to review and interpret denied claims, identify root causes, and determine appropriate solutions. - Excellent written and verbal communication skills to prepare appeals, interact with insurance companies and collaborate with internal teams. - In-depth understanding of medical coding (ICD-10, CPT) and payer-specific guidelines for accurate claims submission and appeal. - Detail-oriented and organized, with the ability to manage multiple claims and appeals efficiently while meeting deadlines. - Strong problem-solving abilities to handle complex denials and work through issues to secure payment. - Ability to track denial trends, report findings and recommend corrective actions. - Knowledge of HIPAA regulations and the ability to maintain patient confidentiality in all aspects of the claims process. Physical Requirements Standing Occasionally (3-33%) Walking Occasionally (3-33%) Sitting Constantly (67-100%) Lifting Occasionally (3-33%) 20lbs - 35lbs Carrying Occasionally (3-33%) 20lbs - 35lbs Pushing Rarely (Less than 2%) Pulling Rarely (Less than 2%) Climbing Rarely (Less than 2%) Balancing Occasionally (3-33%) Stooping Occasionally (3-33%) Kneeling Rarely (Less than 2%) Crouching Rarely (Less than 2%) Crawling Rarely (Less than 2%) Reaching Occasionally (3-33%) Gross Manipulation (Handling) Constantly (67-100%) Fine Manipulation (Fingering) Frequently (34-66%) Feeling Constantly (67-100%) Foot Use Rarely (Less than 2%) Vision - Far Constantly (67-100%) Vision - Near Constantly (67-100%) Talking Constantly (67-100%) Hearing Constantly (67-100%) North Shore Medical Center, Inc. is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.