Claims Denials Management & Resolution Analyst

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Claims Denials Management & Resolution Analyst

Medical Group Business Services

Full Time

86084BR

Job Summary

The Denials Management & Resolution Analyst, under the direction of their Manager and Associate Director, provides support in areas of revenue operations related to coding, auditing, denial management, and training for designated areas. Functions independently with a full understanding of all components of the revenue cycle to complete complex projects of diverse scope and / or portions of large projects.

Responsibilities include Claim Edit and RFI resolution, managing Professional Billing claim denials by conducting a comprehensive review of clinical documentation. Write appeals based on clinical documentation, Letters of Agreement, and the medical policies of the payor, and submit the appeal promptly. Handles audit-related / compliance responsibilities and other administrative duties as required, including but not limited to providing education and training to physicians and clinical staff on documentation to ensure compliance with coding guidelines. Performs an in-depth review of documentation and is responsible for presenting findings along with recommendations to the department on needed education. The position directly impacts hospital and physician reimbursement. This role is key to securing reimbursement and minimizing organizational write-offs.

The incumbent should also be familiar with all applicable billing and coding regulations and be able to effectively communicate these regulations to all levels of faculty, management, and staff. This position will also assign codes based on review of clinical charts, resolve coding issues based on denials, and identify areas of improvement.

The final salary and offer components are subject to additional approvals based on UC policy. Your placement within the salary range is dependent on a number of factors, including your work experience and internal equity within this position classification at UCSF. The annual salary range for this position is $81,300-$172,300, target min. entry point of $97,680+, based on experience. To learn more about the benefits of working at UCSF, including total compensation, please visit : https : / / ucnet.universityofcalifornia.edu / compensation-and-benefits / index.html

Department Description

Medical Group Business Services (MGBS) is responsible for the professional fee billing and collections for approximately 30 divisions in the School of Medicine. MGBS collects approximately $1B annually, and takes ownership for continuing to find ways for the Divisions to ensure charges are captured and increase payments.

Required Qualifications

• Bachelor's degree in a related area or four years of equivalent experience / training.
• Two or more years of coding experience.
• Thorough knowledge of the practices, procedures, and concepts of the healthcare revenue cycle and its component operations, including billing, collections, charge capture, contractual adjustments, third-party reimbursements, and cash management.
• Thorough understanding of the issues, processes, reporting instruments, metrics, analytics, and other tools and techniques involved with measuring and analyzing the revenue cycle.
• Detail-oriented, with proven ability to effectively manage time, see tasks and projects through to completion, organize competing priorities, and effectively address complex, urgent issues as they arise.
• Strong skills in report development, dashboard design, and various software tools specific to healthcare revenue cycle management. Skills in common database, spreadsheet and presentation software.
• Strong communications skills, with the ability to interpret and convey complex clinical finance information in a clear, concise manner. Ability to prepare compelling and informative reports and presentations.
• Strong analytical and problem-solving skills, with the ability to evaluate the effectiveness of workflows and systems and propose innovative solutions.
• Strong interpersonal skills, with the ability to collaborate effectively on complex projects in a team environment with staff from a wide variety of business and clinical areas.
• Proven ability to work with managers, serving as a technical resource, providing recommendations and advice on regulatory changes, and industry trends and developments in revenue cycle management.
• Must have experience working with CPT, ICD-10, E / M Documentation Guidelines (1995 / 1997), CCI edits, Medicare LCD / NCD's, state and federal regulations as well as payor billing requirements.
• Knowledge of medical terminology, anatomy, and physiology

Preferred Qualifications

n / a

License / Certification

Certified Professional Coder in good standing with AAPC, and maintain yearly credits to ensure certification.

About UCSF

At UCSF Health, our mission of innovative patient care, advanced technology and pioneering research is redefining what's possible for the patients we serve - a promise we share with the professionals who make up our team.

Consistently ranked among the top 10 hospitals nationwide by U.S. News & World Report - UCSF Health is committed to providing the most rewarding work experience while delivering the best care available anywhere. In an environment that allows for continuous learning and opportunities for professional growth, UCSF Health offers the ideal atmosphere in which to best use your skills and talents.

Pride Values

UCSF is a diverse community made of people with many skills and talents. We seek candidates whose work experience or community service has prepared them to contribute to our commitment to professionalism, respect, integrity, diversity and excellence - also known as our PRIDE values.

In addition to our PRIDE values, UCSF is committed to equity - both in how we deliver care as well as our workforce. We are committed to building a broadly diverse community, nurturing a culture that is welcoming and supportive, and engaging diverse ideas for the provision of culturally competent education, discovery, and patient care. Additional information about UCSF is available at diversity.ucsf.edu

Join us to find a rewarding career contributing to improving healthcare worldwide.

Equal Employment Opportunity

The University of California is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age, protected veteran status, or other protected status under state or federal law.

Organization

Health

Job Code and Payroll Title

007589 REVENUE CYCLE HC ANL 3

Job Category

Accounting / Finance, Financial

Bargaining Unit

99 - Policy-Covered (No Bargaining Unit)

Employee Class

Career

Percentage

100%

Location

Emeryville, CA

Campus

Emeryville

Work Style

Flexible

Shift

Days

Shift Length

8 Hours