Maxonic maintains a close and long-term relationship with our direct client. In support of their needs, we are looking for a Denials Analyst .

Job Description:

Job Title: Denials Analyst

Job Location: Rancho Mirage, CA

Pay Rate: $25.14 - $26.47

Responsibilities:

Job Objective:

• Responsible for researching and resolving claim denials, ADR requests and certs, submitting and tracking appeals, noting trends and providing monthly reports. Responds to audit requests (including RAC) from payors. 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 future denials.

Essential Responsibilities

1. Demonstrates compliance with Code of Conduct and compliance policies, and takes action to resolve compliance questions or concerns and report suspected violations

2. Analyze denied, underpaid and unpaid claims. Appeal underpaid and denied claims within timely filing periods

3. Identify, track and report on denial trends

4. Maintain an appeals data base to identify and report outcomes and opportunities

5. Identify any billing and/or coding trends resulting in denials and report to the Coding manager

6. Identify any other trends resulting in denials and report to Manager.

7. Attend all available coding and appeals related seminars as available

8. All other duties as assigned

Qualifications:

Qualifications

• Education

o Required: High School diploma or equivalent

o Preferred: Associate degree

• Licensure/Certification

o Preferred: Certified coder or currently enrolled in a coding program

• Experience

o Required: Minimum of two years of Professional Billing with an emphasis in Managed Care denial follow up and appeals processing Prior hospital billing experience a plus.

o Preferred: three to five years of Patient Accounting in a high volume environment.

Specific Skills, Knowledge, Abilities Required

• Strong Analytical skills, Proficient in Microsoft Windows with emphasis on Excel.

• Ability to prioritize and coordinate workflow and attention to detail.

• Knowledge of CPT, HCPC and ICD 10 coding requirements with emphasis on modifiers and diagnosis association.

• Working knowledge of LCD’s, NCCI and MUE edits as well as a general knowledge of Commercial, HMO, and Medicare Advantage claims, authorization and documentation requirements.

About Maxonic:

Since 2002 Maxonic has been at the forefront of connecting candidate strengths to client challenges. Our award winning, dedicated team of recruiting professionals are specialized by technology, are great listeners, and will seek to find a position that meets the long-term career needs of our candidates. We take pride in the over 10,000 candidates that we have placed, and the repeat business that we earn from our satisfied clients.

Interested in Applying?

Please apply with your most current resume. Feel free to contact Leah Cave (leah@maxonic.com / (267) 513-0510) for more details.