Revenue Cycle Denial & Underpayment Specialist

Job Description

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The Revenue Cycle Denial and Underpayment Analyst contributes to the collection of revenue through denial and underpayment appeals. The analyst works assigned claims to correct errors in payment and submitted claim information to optimize the collected revenue for Centra. The goal of the analyst work is to reduce denial dollars and underpayments to increase the bottom line collections for Centra.

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Responsibilities

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Essential Duties and Responsibilities:

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• Comparison of contracted rates versus claim payment to identify underpayments for assigned payers.
• Identify and resolve denials and underpayments.
• Review contract management system to explain and resolve denials and arrange for payment or adjustment.
• Collaborates with other departments to obtain clinical data to resolve denials or underpayments.

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Other Functions

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• Performs special projects as needed and assigned.
• Performs other duties as assigned.

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Qualifications

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Required Qualifications:

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• High School Diploma
• Minimum three (3) years’ experience in denials, underpayments, or healthcare accounts receivable.
• Ability to analyze and reconcile multiple accounts and large volumes of claim data.
• Working knowledge of denial and underpayment processes.

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Preferred Qualifications

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• Certified Coding Specialist
• Certified Professional Coder
• Certified Inpatient Coder