DENIAL MANAGEMENT ANALYST

Montefiore Health System; New York (NY); On-site; USD 50,000 - 62,000; Full time

Job summary

Montefiore Medical Center in Bronx, NY is seeking a denial management specialist to research and analyze denials daily, identify root causes, and submit resubmissions and appeals to overturn denials. The role focuses on maximizing revenue by securing insurer payments and ensuring accurate coding and documentation.

The ideal candidate will have 3–5 years in denial management, CPT/ICD10 knowledge, and certifications such as CPC; EPIC experience preferred.

Qualifications

• Three to five years of progressive experience in appeal/denial management.
• Strong knowledge of CPT coding and ICD10 diagnosis.
• Knowledge of federal, regional and state payer coverage patterns (CMS, etc.).
• Certifications such as CPC preferred; EPIC, HB, PB certifications preferred.

Responsibilities

• Researches and analyzes denials on a daily basis, identifies root causes, and processes resubmissions/appeals to overturn denials.
• Work to maximize revenue for the division by obtaining payments from the insurance carrier.
• Collaborate with staff at all levels to ensure accurate coding and documentation.

Job description

City/State:

Bronx, New York

Grant Funded:

No

Department:

NoMgr

Work Shift:

Day

Work Days:

MON-FRI

Scheduled Hours:

8:30 AM-5 PM

Scheduled Daily Hours:

7.5 HOURS

Pay Range:

$49,920.00-$62,400.00

Researches and analyzes denials on a daily basis, identifies root causes, and processes resubmissions/appeals with the goal of overturning the denial and getting paid by the insurance carrier, maximizing revenue for the division. Three to five years of progressive experience in appeal/denial management- Preferred Strong knowledge of health plan requirements Strong analytical, statistical analysis skills required. Strong knowledge of EPIC, Microsoft Excel, Word and Power Point skills required Knowledge of federal, regional and state payer coverage patterns (CMS, fiscal intermediary, and Administrative Strong organizational and communication skills; professionalism, able to work with all levels of staff. Bachelor’s Degree preferred ( Certified Professional Coder(CPC ) Associate’s Degree required (Medical Billing experience) Certified Professional Coder (CPC) required EPIC Cadence, HB, PB certifications preferred Knowledge of CPT coding and ICD10 diagnosis required Ability to work and effectively multi-task in a fast-paced clinic environment with patients with developmental disabilities.

Montefiore Medical Center is an equal employment opportunity employer. Montefiore Medical Center will recruit, hire, train, transfer, promote, layoff and discharge associates in all job classifications without regard to their race, color, religion, creed, national origin, alienage or citizenship status, age, gender, actual or presumed disability, history of disability, sexual orientation, gender identity, gender expression, genetic predisposition or carrier status, pregnancy, military status, marital status, or partnership status, or any other characteristic protected by law.