Position Summary:
This position serves as Adirondack Health’s primary contact for patient/insurance reimbursement issues in accordance with established policies and payer. The Denials Analyst will be responsible for managing and resolving insurance claim denials, with a focus on surgical and high-dollar accounts, including those with unlisted procedure codes. This role is essential in supporting the revenue cycle’s financial integrity by analyzing trends, coordinating appeals, and collaborating with internal teams to improve first-pass resolution rates and reduce recurring denials. All communication is conducted in a manner that will result in positive patient relations and prompt reimbursement for services.
Educational Requirements/ Qualifications:
Required Minimum Education: High school diploma required. Bachelor’s in business or related field or equivalent combination of education and experience
Required Minimum Experience: Minimum 3 years’ experience in PFS directly involved in billing/collections of accounts receivable. Minimum 3 years’ experience in a lead capacity preferred. Proficiency in knowledge of Third-Party Payers, patient accounts and billing, specifically payer rules, coding guidelines and appeal processes.
Exhibits a strong understanding and ability to interpret payer explanation of benefits. Proficiency in operation of computer terminal and personal computer equipment. Excellent communication when responding to inquiries. Requires effective interpersonal skills and ability to interact with patients and insurance companies to explain payment policies.
Required Skills: Must possess a strong reporting background and advanced knowledge with Microsoft and excel. Strong interpersonal, analytical, problem-solving. Must be comfortable interacting with various employee levels. Demonstrated professionalism and flexibility to work schedules based on need.
Salary Range:
$20.42 - $30.47 per hour
Skills Required
- High school diploma
- Bachelor's degree in business or a related field, or equivalent combination of education and experience
- At least 3 years of experience in patient financial services involving billing and accounts receivable collections
- At least 3 years of experience in a lead capacity
- Knowledge of third-party payers, patient accounts, billing, payer rules, coding guidelines, and appeal processes
- Ability to interpret payer explanations of benefits
- Proficiency using computer terminals and personal computers
- Strong reporting background and advanced Microsoft Excel knowledge
- Strong interpersonal, analytical, problem-solving, communication, professionalism, and schedule flexibility skills
What We Do
Adirondack Health is a non-profit healthcare network and the largest healthcare provider in the six-million-acre Adirondack Park. It provides a comprehensive range of medical and surgical services, primary care across multiple health centers, and long-term care at skilled nursing and rehabilitation facilities, serving both residents and visitors in the Adirondack region.
