Strategic Denials & Reimbursement Analyst

SGMC Health; Valdosta (GA); On-site; USD 55,000 - 75,000; Full time

Benefits offered by this job

Low Healthcare Insurance Premiums

401(k) with employer match

Paid Time Off (PTO)

Employee discounts

Company paid life insurance

Disability insurance

Tuition Reimbursement

Job summary

SGMC Health is seeking a Denials Management Analyst who will analyze managed care payment methodologies and interpret payer contracts to resolve denials. The role includes reviewing and trending payer contractual adjustments and consulting with various teams to coordinate rebilling and follow-up activities.

The ideal candidate possesses in-depth knowledge of insurance processes and coding, as well as strong communication skills. Full-time position with benefits including healthcare insurance and 401(k) with matching.

Qualifications

• In-depth knowledge of insurance/managed care processes.
• Experience with CPT-4, HCPCS, and ICD-10 coding systems.
• Clinical and professional coding background beneficial.

Responsibilities

• Analyze managed care payment methodologies.
• Review and trend payer contractual adjustment variances.
• Consult with various departments for proper reimbursement.

Skills

PC and Windows literacy

Insurance/managed care knowledge

Communication skills

Organizational skills

Typing speed of 40 wpm

Education

College degree or coursework

CPAR certification

Tools

EPIC PB Resolute

Microsoft Excel

Microsoft Office applications

Job description

SGMC Health is seeking a Denials Management Analyst who will analyze managed care payment methodologies and interpret payer contracts to resolve denials. The role includes reviewing and trending payer contractual adjustments and consulting with various teams to coordinate rebilling and follow-up activities.

The ideal candidate possesses in-depth knowledge of insurance processes and coding, as well as strong communication skills. Full-time position with benefits including healthcare insurance and 401(k) with matching.