Reconciliation/Denial Analyst

Overview

Our team members are the heart of what makes us better.

At Hackensack Meridian Health we help our patients live better, healthier lives - and we help one another to succeed. With a culture rooted in connection and collaboration, our employees are team members. Here, competitive benefits are just the beginning. It's also about how we support one another and how we show up for our community.

Together, we keep getting better - advancing our mission to transform healthcare and serve as a leader of positive change.

The Reconciliation/Denial Analyst provides statistical and financial data enabling management to accurately monitor accounts receivable activity on an ongoing basis for the Hackensack Meridian Health (HMH) network. Identifies issues for management regarding significant changes in various accounts receivable categories reflected in the daily dashboards and denial reports. Supports the Revenue Operations team by monitoring key metrics related to revenue and accelerated cash flow. This position performs high level analysis of accounts receivable and denials uses considerable judgment to determine solutions to complex problems. All tasks must be performed in a timely and accurate manner. Meets with appropriate Revenue Operations leaders and makes recommendations to prevent future denials and payment variances. Disciplines include, but are not limited to, Patient Accounting, Case Management, Health Information, Clinical, Training, Managed Care, and IT.

Responsibilities

A day in the life of a Reconciliation/Denial Analyst at Hackensack Meridian Health includes:

• Identifies and performs root cause analysis of the high volume denials and presents the findings to the Revenue Operations team. Communicates improvement opportunities and corrective action based on findings. When appropriate, bring issues to closure to prevent multiple hand-offs.
• Performs analytical review of denials to support Patient Financial Services, Case Management, Access, and other departments as it relates to denials. Determines reason for denials, meets with appropriate Revenue Operations leaders, and makes recommendations to prevent future denials.
• Identifies problems in process workflow and/or changes in payer's billing rules and regulations and governmental guidelines that slows cash flow and disseminates information to management.
• Collaborates with the Training department on developing education materials based from the resolution /outcome of the improvement opportunities presented at interdisciplinary meetings.
• Collaborates with Reconciliation/Denial Manager in developing process and workflow on trends identified on various areas of operation.
• Prepares trending reports of all high volume denials utilizing Slicer Dicer, Reporting Workbench and other tools. Meets biweekly and monthly with various departments to communicate findings and make recommendations to improve revenue management.
• SME (Subject Matter Expert) for complex denials and payment variances including contracts, fee schedules, and edits. Educates and provides feedback to various areas on Revenue Operations metrics and key performance indicators.
• Utilizes and develops new Epic and ad-hoc accounts receivable or denial reporting tools for management, using the current information system and/or other software programs to achieve desired reporting outcomes.
• Performs reimbursement management and tracks and reports on high volume discrepancies which will be used as escalation to Managed Care, the payer, or IT. Monitors denials and initiates CPT or DRG analysis to determine reason for denial.
• Monitors daily dashboard and reports and conducts analytical reviews to determine if changes or enhancements on current policies and procedures are required.
• Participates in meetings with appropriate personnel to exchange ideas on working towards accounts receivable related changes or enhancements and works closely with the Follow-Up Manager to develop required reports for meetings.
• Conducts accounts receivable audits as defined by SVP, Sr Revenue Officer and Patient Financial Services Managers.
• Meets bi-weekly and monthly with various vendors and outsource agencies to discuss bottlenecks in revenue flow and discusses solutions. Acts as liaison between agencies and Reconciliation department to prevent accounts receivable aging and ensures timely flow of communication.
• Monitors account work queues, analyzes trends, and follows up if metrics exceed or fall below baselines.
• 1Collaborates with Revenue Operations Analyst and Billing Analyst as needed.
• Able to perform all Reconciliation Representative functions/tasks.
• Able to support the Cash Posting and Remittance team in all functions and tasks.
• Able to create and design reports using various reporting tool, that can be presented visually to management.
• Conduct weekly meetings with various departments that are the source of denials, collaborate for finding root cause, resolution and prevention.
• Other duties and/or projects as assigned.
• Adheres to HMH Organizational competencies and standards of behavior.

Qualifications

Education, Knowledge, Skills and Abilities Required:

• BA/BS degree in accounting, business, healthcare administration or a related field; or equivalent relevant HMH experience at approximately 1 to 2 years.
• Minimum of 2 years of experience in a healthcare billing office or health insurance claims environment.
• Familiar with common medical billing practices, concepts, and procedures.
• Excellent analytical and critical thinking skills.
• Ability to work in a fast paced business office.
• Must be able to coordinate multiple projects with multiple deadlines or changing priorities.
• Strong attention to details.
• Proficient with computer applications including Microsoft Office Suite with strong Excel skills/Google Suite.
• Must be highly organized and possess excellent time management skills.
• Strong written and verbal communication skills.
• Knowledge of ICD-9/10 and medical terminology.
• Must become Epic Credentialed and/or take and pass Epic online Patient Accounting, ADT and Prelude proficiency courses within 6 months of hire and/or promotion,
• Must be proficient in use and understanding of Third Party Payers Portals.

Education, Knowledge, Skills and Abilities Preferred:

• Prior experience in a Patient Financial Services department for a university medical center/hospital or a Health Insurance Payer.
• Knowledge of Managed Care Contracts, Medicare, and Medicaid.
• Excellent Epic Skills, Strong knowledge of Real Time Eligibility and Change Health Care-Assurance.
• Excellent report writing skills.

Licenses and Certifications Required:

• Certification or Proficiency in Epic HB Fundamentals within in 6 months of hire.
• Certification or Proficiency in Epic HB Insurance Follow-Up within 3 months of hire.
• Successfully pass completion of EPIC assessment within 30 days after Network access granted.

If you feel that the above description speaks directly to your strengths and capabilities, then please apply today!

Our Network

Hackensack Meridian Health (HMH) is a Mandatory Influenza Vaccination Facility

As a courtesy to assist you in your job search, we would like to send your resume to other areas of our Hackensack Meridian Health network who may have current openings that fit your skills and experience.