Hospital - Denial Management Analyst

• Review Denied Claims: Analyze denied insurance claims to determine the root cause of denials and identify corrective actions.
• Respond to Payer Audits: Prepare and submit required documentation, including medical records, for payer-requested audits and prepayment reviews.
• Appeal Denials: Develop and submit appeals using medical records, appeal letters, and other supporting documentation to recover denied revenue.
• Trend Analysis: Analyze denial and audit trends to identify patterns and recommend process improvements to reduce future denials.
• Verify Coding Accuracy: Work with corresponding departments to ensure proper ICD-10, CPT, and HCPCS codes are applied in the electronic medical record (EMR) and billing systems.
• Contract Review: Review managed care contracts to verify the appropriate application of reimbursement rates, provisions, and terms.
• Negotiate Resolutions: Communicate with payers to resolve technical denials and ensure compliance with contract provisions and guidelines.
• Track Appeals and Outcomes: Maintain detailed records of appeals, their statuses, and outcomes to ensure timely resolution and accurate reporting.
• Support Process Improvement: Collaborate with clinical denial management and revenue integrity teams to implement strategies that minimize claim denials.
• Educate Staff: Act as a resource for team members on denial reasons, payer-specific policies, and the appeals process, escalating issues when necessary.
• Stakeholder Collaboration: act as a liaison between internal departments and external parties (e.g., payers, auditors) to address claim and audit issues.
• Ensure all work is performed with strict confidentiality while adhering to production and quality goals.
• Handle high-level appeals, including preparing documentation and negotiating outcomes with insurance companies.
• Manage escalated claims with significant financial impact, such as underpayments or disputed claims.
• Conduct root cause analysis on recurring denial issues and recommend solutions.
• Perform all other duties as assigned by supervisor or manager.

• Highly detail-oriented with advanced organizational and prioritization skills, capable of managing complex and high-priority projects concurrently.
• Expert proficiency in Microsoft Word, Excel, PowerPoint, and Outlook
• Exceptional verbal and written communication skills, including drafting high-level memorandums, letters, and official correspondence.
• Expert knowledge of hospital billing, appeals processes, and denial management, with the ability to handle complex payer disputes, escalated claims and audits.
• In-depth understanding of payer contracts, Medicare/Medicaid guidelines, and audit requirements.
• Strong familiarity with industry best practices in revenue cycle management.
• Proficient in navigating office software, billing systems, and abstracting tools, with demonstrated expertise in using coding resources.
• Advanced understanding of insurance authorizations, benefits, coverage, and eligibility as they relate to medical billing.
• Expertise in reimbursement practices and payer-specific requirements, ensuring compliance and optimal reimbursement.
• Ability to mentor and guide Tier 1 and Tier 2 billers in billing processes and denial resolutions.
• Expertise in conducting root cause analysis and providing solutions to recurring billing issues.
• Stay current on payer-specific guidelines, industry trends, and regulatory requirements to ensure compliance and billing efficiency.

Education:

• Associate's degree in a related field required

This position may require the ability to maintain the security and integrity of UT San Antonio and its infrastructure per Texas EO-GA-48.