Denials Management Analyst

Best Care; United States; Hybrid; USD 42,000 - 62,000; Full time

Job summary

Nebraska Methodist Health System is seeking a Billing Specialist to review denials, analyze payments, and ensure maximum reimbursement under payer contracts and CMS regulations. The role includes collaborating with internal teams, supporting staff, and training on contract reimbursement processes.

Location: Omaha, NE; Schedule: Mon–Fri; potential for remote work after training. Strong knowledge of ICD/CPT, DRG, UB/HCFA formats, and payer websites is preferred.

Qualifications

• High School Diploma or GED is required.
• College coursework in accounting or health care is preferred.
• 1–2 years of experience with a 3rd party payer or health care provider.
• At least 1 year of insurance billing experience is preferred.
• Six months DRG reimbursement experience preferred.
• Experience researching institutional and professional claims for contract reimbursement.

Responsibilities

• Analyze denials against contracts, payer policies, NMHS coding, and authorization processes.
• Analyze payments to ensure accuracy and initiate corrective action with payers.
• Maintain follow-up and reporting to ensure reimbursement.
• Research contractual and reimbursement issues and respond to inquiries.
• Assist staff with workload and respond to special requests.
• Participate in payer meetings and escalate payer issues.
• Provide training on contracts and reimbursement to other areas as needed.

Skills

Microsoft Office

Data entry

Verbal communication

Written communication

Medical terminology

Payer websites

UB/HCFA billing formats

ICD knowledge

CPT knowledge

DRG knowledge

Confidentiality

Data analysis

Education

High School Diploma or GED

College coursework in accounting

College coursework in health care

Tools

None

Job description

Why work for Nebraska Methodist Health System?
At Nebraska Methodist Health System, we focus on providing exceptional care to the communities we serve and people we employ. We call it The Meaning of Care – a culture that has and will continue to set us apart. It’s helping families grow by making each delivery special, conveying a difficult diagnosis with a compassionate touch, going above and beyond for a patient’s needs, or giving a high five when a patient beats a disease or conquers a personal health challenge. We offer competitive pay, excellent benefits and a great work environment where all employees are valued! Most importantly, our employees are part of a team that makes a real difference in the communities we live and work in.

Job Summary:

Location: Methodist Corporate Office
Address: 825 S 169th St. - Omaha, NE

Work Schedule: Mon - Fri, 7:00am to 3:30pm

*Able to work from home after successfully completing the training process and achieving acceptable quality and production goals.

Responsible for review of denials for commercial / government, physician / facility and escalation of appeals to the payers as needed to obtain the maximum reimbursement in compliance to payer contracts and CMS regulations.

Responsibilities:

Essential Job Functions

1. Analyze denials compared to the applicable contract agreements, payer medical policy language, NMHS coding and authorization processes.

• Analyze payments to ensure accuracy and initiate corrective action with third party payers.
• Demonstrates understanding of contract and reimbursement language.
• Maintain a follow up and reporting system to ensure receipt of reimbursement.

1. Analyze and research contractual and reimbursement issues and answers inquiries from internal and external sources.

• Correct handling of denial.
• Resolve denial in RCA according to department policy.
• Timely follow-up of denials, appeals, etc.

1. Assist staff with work volume as needed.

• Respond to special requests with accurate information.
• Provide contract/payor recommendations.

1. Participate in payer meetings and escalates payer issues.

• Assist with tracking payer agenda issues.

5. Provide training on contracts and reimbursement to other areas as needed.

Schedule:

Mon - Fri, 7:00am to 3:30pm

Job Description:

Job Requirements

Education

• High School Diploma or General Educational Development (G.E.D.) required.
• College coursework in accounting and or health care preferred.

Experience

• Minimum 1-2 years experience working for a 3rd party payer or health care provider required.
• Minimum 1 year of insurance billing experience preferred.
• Six months Institutional and Professional ICD and CPT coding preferred.
• Six months experience with DRG reimbursement and outpatient including ASC grouper, ER and outpatient reimbursement preferred.
• Experience in researching Institutional and Professional claims to determine correct contract reimbursement using payer contracts preferred.

License/Certifications

• N/A

Skills/Knowledge/Abilities

• Skill using Microsoft Office, including Word, Excel, and Outlook.
• Skill performing 10 key data entry.
• Skill with verbal and written communication.
• Knowledge of medical terminology.
• Knowledge of patient accounting software and payer websites.
• Knowledge of Universal Billing (UB) and Healthcare Financing Administration (HCFA) billing formats.
• Knowledge of International Classification of Disease (ICD), Current Procedural Terminology (CPT), Revenue Codes, understanding of DRG methodology.
• Knowledge of facility contracting rates.
• Knowledge of CMS (Center for Medicare and Medicaid Services).
• Knowledge of WPS ANSI remark codes.
• Ability to maintain confidentiality.
• Ability to read and understand payer explanation of benefits (EOB).
• Ability to use basic accounting and math principles.
• Ability to identify, trend and analyze data.
• Ability to learn new software programs.
• Ability to organize and prioritize work.
• Ability to work independently.
• Ability to identify and trend issues to improve or streamline processes.
• Ability to maintain a professional demeanor with internal and external contacts.

Physical Requirements

Weight Demands

• Light Work - Exerting up to 20 pounds of force.

Physical Activity

• Occasionally Performed (1%-33%):

  • Balancing
  • Climbing
  • Carrying
  • Crawling
  • Crouching
  • Distinguish colors
  • Kneeling
  • Lifting
  • Pulling/Pushing
  • Reaching
  • Standing
  • Stooping/bending
  • Twisting
  • Walking

• Frequently Performed (34%-66%):

  • Hearing
  • Repetitive Motions
  • Seeing/Visual
  • Speaking/talking

• Constantly Performed (67%-100%):

  • Grasping
  • Keyboarding/typing
  • Sitting

Job Hazards

• Not Related:

  • Biological agents (primary air born and blood born viruses) (Jobs with Patient contact) (BBF)
  • Physical hazards (noise, temperature, lighting, wet floors, outdoors, sharps) (more than ordinary office environment)
  • Equipment/Machinery/Tools
  • Explosives (pressurized gas)
  • Electrical Shock/Static
  • Radiation Alpha, Beta and Gamma (particles such as X-ray, Cat Scan, Gamma Knife, etc)
  • Radiation Non-Ionizing (Ultraviolet, visible light, infrared and microwaves that causes injuries to tissue or thermal or photochemical means)

• Rare (1-33%):

  • Chemical agents (Toxic, Corrosive, Flammable, Latex)
  • Mechanical moving parts/vibrations

• Note: Safety Officer can assist with identification of job hazards

About Methodist:

Nebraska Methodist Health System is made up of four hospitals in Nebraska and southwest Iowa, more than 30 clinic locations, a nursing and allied health college, and a medical supply distributorship and central laundry facility. From the day Methodist Hospital was chartered in 1891, service to our communities has been a top priority. Financial assistance, health education, outreach to our diverse communities and populations, and other community benefit activities have always been central to our mission.

Nebraska Methodist Health System is an Aff…??