Claims Denial Escalation Analyst - Corporate

Claims Denial Escalation Analyst - Corporate | Summit Healthcare Mgmt | Nashville, Tennessee

About the Job:

The Claims Denial Escalation Analyst is responsible for reviewing denials and underpayments that occur on a daily basis, validating the denial or underpayment and generate appeals for denied or underpaid claims.

Roles and Responsibilities:

• Validate denial reasons whether clinical or technical.  

• Conduct root cause analysis to determine patterns and trends in denials.  

• Develop and implement strategies to reduce claim denials and improve reimbursement rates.  

• Prepare and submit appeal letters to insurance companies, ensuring compliance with payer guidelines.  

• Identify opportunities for process improvements to reduce future denials. Collaborate with various departments such as UR, Admissions, HIM to discuss issues causing denials.  

• Generate and analyze reports on denial rates and resolution outcomes.  

• Monitor key performance indicators (KPI’s) such as initial claim denial rates and denial recovery rate percentage.  

• Research underpayments and review contract fee schedule to determine if account was underpaid.  

• Contact payer via phone or written appeal of underpayments.  

• Develop relationships with payer provider representatives to review denials and underpayment and to escalate payment on appeals.  

• Expectation that 25-30 accounts a day will be reviewed and appropriate action taken.  

Education/Experience/Skill Requirements:

• High School degree or GED, prefer 2-year community college degree. 

• 3- 5 years’ experience in healthcare billing or collections.  

• Proficiency in Microsoft Office Suite.  

• Excellent attention to detail and organizational skills.  

Why Summit Healthcare Mgmt?Summit Healthcare Mgmt offers a comprehensive benefit plan and a competitive salary commensurate with experience and qualifications. Qualified candidates should apply by submitting a resume. Summit Healthcare Mgmt is an EOE.

Veterans and military spouses are highly encouraged to apply. Summit BHC is dedicated to serving Veterans with specialized programming at our treatment centers across the country. We recognize and value the unique strengths of the military community in supporting our mission to serve those who have served.