Payor Reimbursement Analyst: Denials & Appeals Expert

Children's National Medical Center; Silver Spring (MD); On-site; USD 87,000 - 145,000; Full time

Job summary

Children's National Medical Center in Silver Spring, MD seeks a Payor Reimbursement Analyst to support Medicaid and Commercial payors through timely and thorough review of authorizations and denials. You will track, trend and report data to Revenue Cycle and collaborate with Access, Clinics, Managed Care, Business Operations, Leadership and Legal.

Qualifications include a BSN (Required) and 5 years of experience with 3 years in Utilization Review, plus strong communication and writing skills.

Qualifications

• Must have strong logic and critical thinking in dynamic healthcare environments.
• Requires superior verbal communication skills and service excellence with stakeholders.
• Must have strong business writing skills.
• Proficient with keyboarding and Microsoft Office Excel, Access and PowerPoint.

Responsibilities

• Timely, comprehensive review of authorizations/denials to determine appropriate action.
• Provide clear direction to others to resolve authorization/denial issues.
• Provide timely appeals based on standardized criteria (Interqual and MCG) with escalation.
• Monitor payor responses to appeals to ensure timely claim payment or write-off.
• Function as a subject matter expert for CRM, Revenue Cycle and the organization.

Skills

Critical thinking

Verbal communication

Business writing

MS Excel

MS Access

PowerPoint

Education

BSN (Required)

Master's Degree (Preferred)

Job description

Children's National Medical Center in Silver Spring, MD seeks a Payor Reimbursement Analyst to support Medicaid and Commercial payors through timely and thorough review of authorizations and denials. You will track, trend and report data to Revenue Cycle and collaborate with Access, Clinics, Managed Care, Business Operations, Leadership and Legal.

Qualifications include a BSN (Required) and 5 years of experience with 3 years in Utilization Review, plus strong communication and writing skills.