Revenue Cycle Analyst

AA2IT; Fort Worth (TX); On-site; USD 65,000 - 90,000; Full time

Job summary

AA2IT is seeking a Revenue Cycle Clinical Denials Specialist in Texas to manage complex clinical denials, perform root cause analysis, and file compelling appeals based on clinical documentation and payor policies.

The role requires Epic HB Resolute experience, strong analytical and communication skills, and the ability to track trends and drive process improvements in a hospital Revenue Cycle setting.

Qualifications

• Must have Epic Systems Revenue Cycle Solutions (HB Resolute) experience.
• Experience with clinical denials management and appeals.
• Knowledge of insurance billing principles and payor policies.
• Understanding of regulatory compliance in billing and coding.

Responsibilities

• Manage denial and appeal workload and communicate results to stakeholders.
• Perform root cause analysis on denials to identify trends.
• Draft and submit professional appeals based on clinical docs and policies.
• Monitor payor guidelines to ensure timely submission and resolution.
• Support audit/compliance activities and maintain key process documentation.

Skills

Clinical denials management

Appeals writing

Medical billing & coding

Payor contracts & policies

Regulatory compliance

Analytical reasoning

Communication skills

Team coordination

Education

High School/Equivalent

Tools

InterQual

Milliman Care Guidelines

Job description

Job Description

Job Description

Must Have: Prior experience with Epic Systems Revenue Cycle Solutions (HB Resolute) required
The Revenue Cycle Clinical Denials Specialist will perform advanced level work related to clinical denials management and root cause analysis. Responsibilities include managing claim denials related to authorization, referral, late notifications, level of care, medical necessity, experimental and investigation, and all other denials as assigned. The Revenue Cycle Clinical Denials Specialist conducts comprehensive review of the claim denial(s), account and/or charge reconciliation, and all clinical documentation to determine the root cause and appropriate resolution.
The Clinical Denials Specialist will write and submit professionally written appeals to encompass compelling arguments based on clinical documentation, payors' clinical and medical policies, including CCHCS contract and reimbursement language, as appropriate. Appeals and/or reconsiderations should follow payor guidelines and regulations to ensure timely submission. The position will also track denial trends through outcome, identify recurring issues, and provide process improvement opportunities to minimize future denials through education. The Clinical Denials Specialist will also share responsibility for audit-related and compliance; and other administrative duties as required.
The position will manage, maintain and communicate denial and appeal activity to the appropriate stakeholders, and report emerging trends to Revenue Cycle leadership. The Revenue Cycle Clinical Denials Specialist anticipates and responds to a variety of issues and concerns; including organizing activities directly affecting hospital reimbursement and assists in creating and maintaining documentation of key processes.
The individual works independently to plan and organize activities that directly influences hospital reimbursement and assists in creating and maintaining documentation of key processes. This role is essential to securing reimbursement and minimizing organizational adjustments under the direction of Revenue Integrity leadership.

Skills:

• Ability to construct an effective argument related to clinical denials for hospital services.
• o Knowledge of health plan operations, reimbursement methodologies, payor contracts and clinical and medical policies.
• o Working knowledge of state, federal and compliance regulations as they pertain to coding and billing processes and procedures.
• o Strong understanding of medical billing principles, insurance coding (CPT, HCPCS, ICD-10 and billing forms), medical and insurance terminology, and payor polices, and appeals processes.
• o Excellent written and oral communication skills to manage complex appeals, reconsiderations and denials.
• o Ability to ensure a high-level of customer satisfaction for internal and external stakeholders.
• o Basic math skills and knowledge of healthcare related financial and/or accounting practices.
• o Ability to maintain strong relationships with various clinical and non-clinical team members that positively affect financial outcomes.
• o Analytical skills, attention to detail, excellent communication, and strong problem-solving abilities.
• o Working knowledge of medical decision-making criteria tools (InterQual, Milliman Care Guidelines).
• o Ability to deal effectively with constant changes and be a change agent.
• o Possesses the ability to work in a constantly changing environment, good judgement skills, and capable of making decisions with attention to detail. Prior experience with Epic Systems Revenue Cycle Solutions (HB Resolute) required

Education: High School/Equivalent

Company Description

At AA2IT, we deliver solutions that align with your business goals, built on innovation, backed by a team of experts, and guided by measurable outcomes.

Company Description

At AA2IT, we deliver solutions that align with your business goals, built on innovation, backed by a team of experts, and guided by measurable outcomes.