Denials Analyst

Eisenhower Health; Rancho Mirage (CA); On-site; USD 65,000 - 90,000; Full time

Job summary

Eisenhower Health is seeking a Revenue Cycle professional to research and resolve claim denials, handle ADR requests and certificates, and track appeals. The role involves identifying trends, producing monthly reports, and responding to RAC audit requests.

You will collaborate with Admitting, Coding, and Provider Liaisons to drive process improvements. Responsibilities include maintaining a payer reference library, staying current on preauthorization and documentation requirements, and

Qualifications

• Experience with denial management and payer audits preferred.
• Knowledge of RAC/UR/appeals processes beneficial.
• Strong analytical and problem-solving skills.

Responsibilities

• Investigate and resolve claim denials and ADR requests.
• Submit and track payer appeals; monitor outcomes for trends.
• Maintain a reference library of payer requirements for preauthorization and documentation.

Job description

Job Objective

Researches and resolves claim denials, ADR requests and certs; submits and tracks appeals, notes trends and provides monthly reports. Responds to audit requests (including RAC) from payors and maintains a Library of Payer reference material regarding requirement for pre authorization, medical necessity and documentation requirements. Works with the Revenue Cycle stakeholders (e.g. Admitting, Coding, Provider Liaisons, etc.) to provide information related to denials and opportunities for process improvement.