Appeals Analyst - PFS CCD Revenue Integrity - Sharp Corporate - Day Shift - Full Time

300 Sharp HealthCare; United States; On-site; USD 36,000 - 51,000; Full time

Job summary

Sharp HealthCare in San Diego, CA is seeking a billing analyst to appeal underpayments and manage payer contract issues. The role requires strong analytical skills, Excel proficiency, and experience with denials across multiple specialties.

You will file appeals, analyze EOBs, and help improve revenue recovery by identifying root causes and communicating findings to management. Flexible start times and shift options reflect our commitment to efficient operations.

Qualifications

• H.S. Diploma or Equivalent; 5 years billing experience and 4 years accounts management in a multi-specialty medical group.
• Must have strong analytical and mathematical skills; detail oriented.
• MS Excel proficiency and familiarity with billing procedures.
• Experience resolving underpayments/denials and payer contract issues.

Responsibilities

• File appeals and PDRs on non-clinical underpaid/denied claims.
• Explain new legislation affecting underpayments/denials.
• Identify underpayment trends and opportunities for revenue.
• Produce ad hoc reports to reconcile inventory and revenue.
• Maintain timely, accurate communication with supervisor and management.

Skills

Strong analytical skills

Mathematical skills

Detail oriented

Communication

Team player

Education

HS Diploma or Equivalent

Bachelor's Degree in finance, business administration or economics

Tools

MS Excel

Billing software

Contract Underpayment tool

Job description

Hours: Shift Start Time: Variable Shift End Time: Variable AWS Hours Requirement: 8/40 - 8 Hour Shift Additional Shift Information: Flexible start time between 5 - 7 AM Weekend Requirements: No Weekends On-Call Required: No Hourly Pay Range (Minimum - Midpoint - Maximum): $26.320 - $32.890 - $36.830 The stated pay scale reflects the range that Sharp reasonably expects to pay for this position. The actual pay rate and pay grade for this position will be dependent on a variety of factors, including an applicant’s years of experience, unique skills and abilities, education, alignment with similar internal candidates, marketplace factors, other requirements for the position, and employer business practices.

What You Will Do

To appeal for underpayments compared to contract rates. Escalate payer contractual issues to payers and management of Sharp.

Required Qualifications

H.S. Diploma or Equivalent 5 Years experience in all areas of billing and 4 years accounts management experience in a multi specialty medical group.

Preferred Qualifications

Bachelor's Degree with emphasis in finance, business administration or economics.

Experience in resolving difficult underpayment/denial issues, categorizing inventory into underpayment reasons, identifying root cause, recognizing trends and clearly and persuasively articulating issues to payor.

Essential Functions

Financial analysis and reporting Successfully file appeals/PDR's on non-clinical underpaid/denied claims and maintain standardized letters for use in training of account analysts. Required to explain new legislation impacting underpayments/denials etc. Trend and identify underpayment/denial issues for training purposes with the goal of mitigating future underpayments/denials. Work on ad hoc reports to reconcile inventory or identify opportunities for increased revenue collection using reporting tools. Assure the current quarterly, monthly, yearly insurance rates are obtained and loaded into the Contract Underpayment tool for accurate expected rate analyzation. Productivity Focus appeal efforts on underpayments/denials with highest propensity for recovery, considering Payor appeal timeframes, Payor contract reimbursement, underpaid/denial reason, facility, patient type. Regularly meet projected collection goals and appeal productivity standards. Maintains excellent communication with supervisor/management and high accuracy of work. Quality Using underpayment tool and billing software, review payor EOB, contract, payor website, etc. necessary to support basis for appeal. Must be cross‑trained and file appeals outside assigned payor mix in the absence of fellow team member. Commence direct follow up action on appeals filed according to time frames.

System integration

Provide ongoing training/feedback to account analysts to improve success rate on initial appeals/PDR's filed. Participate in meetings with Management, to review and consult on appeal denial trends to determine next step/action plan towards resolution. Other duties, as assigned.

Knowledge, Skills, and Abilities

Must possess strong analytical and mathematical skills to resolve underpayment inventory. Must be detail oriented and possess a diligent work ethic. Strong communication and excellent interpersonal skills. Team Player. Knowledge of benefits, covered services, Managed Care (contract payor) reimbursement and billing procedures of both government and non-government insurance programs. Familiarity with current regulations of affiliated payors. Familiarity with MS excel required. Knowledge of ICD‑9 and CPT‑4 codes, and basic medical terminology.

Sharp HealthCare is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability or any other protected class Sharp HealthCare is a not‑for‑profit health care system based in San Diego, California, with four acute care hospitals, three specialty hospitals, three medical groups and a health plan. We provide medical services in virtually all fields of medicine, including primary care, heart care, cancer, orthopedics, women’s health, rehabilitation, robotic surgery and bariatric surgery. Sharp sets the community standard for exceptional care. Sharp Grossmont Hospital and Sharp Memorial Hospital have received prestigious Magnet recognition by the American Nurses Credentialing Center for excellence in nursing practices and quality patient care. At the heart of our organization are more than 18,000 affiliated physicians, nurses, staff and volunteers who are on a journey to make health care better for our patients and their families. It’s what we call The Sharp Experience – treating each person with dignity, compassion and respect, and using our clinical excellence and advanced technology to deliver the highest‑quality patient care. We are dedicated to transforming the health care experience by making Sharp the best place to work, the best place to practice medicine and the best place to receive care in San Diego.