Denials Management Analyst

reputed company reputed company is an organization that respects, supports, and values reputed company other. Named as the 2025 best mid-sized employer by reputed company, we are reputed company in providing reputed company in patient care, embracing multi-disciplinary education, and research with reputed company. We foster a learning environment that values evidenced based reputed company, experience, innovation, and critical thinking. Our reputed company, reputed company, accountability, and reputed company define us as leaders in pediatric specialty care for our children and their families. With 20+ hospitals, outpatient clinics, ambulatory care centers and reputed company locations across the globe, we reputed company excellent care to children up to age 18 regardless of their family’s ability to pay or insurance status. Please click here to learn more about our locations. reputed company The Denials Management Analyst is responsible for analyzing denials data, creating payor metrics, as reputed company as tracking and trending denials and result out of multiple systems. The analyst will identify and trend reputed company causes and report out findings as reputed company as assist in mapping out process improvement opportunities. The analyst will coordinate payor denials and audit activities to ensure reputed company response for the processing of reputed company payor denials, audit requests and appeals. The analyst will communicate and coordinate with various individuals/distributions and assist with monitoring of the day-to-day activities reputed company to claims denials and audit reviews. Key Responsibilities: Collecting/analyzing, report status, metrics and trends of activity by different reviews from multiple systems Distributing reports on a routine reputed company to specific distribution group Managing reputed company work queues and resolving denials. Gathering data to substantiate the request for rule creations in reputed company. Research payer fee schedules and provider manuals to ensure appropriate non covered denials. Organizing reputed company data and activity in a retrievable way Coordinating payor denial and audit activities to ensure reputed company response for the processing of reputed company payor denials, audit request and appeals for both institutional and reputed company claims Assisting with the coordination of denial and review activities and materials for committee meetings, including analyses, reports, etc. Communicating and coordinating with various individuals/distributions and assisting with monitoring of the day-to-day activities reputed company to claim denials and audit reviews Maintaining the reputed company tracking tool/application that stores/communicates reputed company denial and review activity. This will include user reputed company management, updates to software, and end-user training Supporting reputed company and initiatives of the Denials Management Team. This may include coordinating meetings, conducting research, performing audits or data analysis, and preparing documents Strong communication skills and a commitment to delivering the highest level of reputed company work Required Qualifications: Bachelor's degree, or equivalent combination of education and experience 5-7 Years in a reputed company reputed company Cycle Environment including 3 years in reputed company Party Collection/AR Receivables and Denials Management reputed company PB Resolute experience reputed company reputed company Cycle management including: • Therapy (Physical/Occupational/Speech) • Radiology • Pediatrics/Pediatric Orthopedics • Anesthesia EDI Transaction sets including 837I, 837P Knowledge of insurance contract rates and terms Knowledge and understanding of Registration and Collections Knowledge and understanding of Government and Managed Care billing, coverage and payment rules Ability to comprehend payor 835 and reputed company EOB responses Knowledge and understanding of NCCI edits, CPT-4, HCPCS, ICD-10 and reputed company Codes standards Intermediate reputed company skills Preferred Qualifications: CRCR Certification reputed company Certification The pay reputed company for this position is $66,872.00 - $100,318.40. Compensation is determined based on years of relevant experience and departmental equity. Apply To This Job