Denials Management Analyst - Medical Records

Overview

Department: Medical Records

Schedule: Full Time, Days

Facility: Central Maine Medical Center

Location: Lewiston, Maine, 04240

 

Central Maine Healthcare (CMH), a member of Prime Healthcare Foundation, is an integrated healthcare delivery system serving approximately 400,000 residents across central, western, and midcoast Maine through a network of more than 40 primary and specialty care locations. The system includes Central Maine Medical Center  (CMMC) in Lewiston, a 250-bed, not-for-profit regional referral hospital that is home to the region's only Cancer Care Center, an orthopedic ambulatory surgery center, and the Central Maine Heart and Vascular Institute. CMMC also serves as the central Maine base for LifeFlight of Maine, the state's only medical helicopter service.

 

CMH also includes Bridgton Hospital and Rumford Hospital, two 25-bed critical access hospitals that provide essential care to Maine's rural communities.

 

As part of its commitment to healthcare education and workforce development, CMH is home to the Maine College of Health Professions, Maine's first nursing and medical imaging school. The private, not-for-profit institution is accredited by the New England Commission of Higher Education and plays an important role in training the next generation of healthcare professionals.

 

To learn more, visit www.cmhc.org.

Responsibilities

Responsible for the identification, analysis and resolution of technical based denials from insurance payers. The analyst will work with revenue cycle staff and insurance payers (Governmental/Non-Governmental) to identify the source of denials and develop processes to eliminate and/or minimize denials and rejections to improve cash flow. The analyst works denied and underpaid accounts to obtain full reimbursement for services provided through effective appeal writing as well as identify denial and underpayment root causes. 

Qualifications

1-year experience of experience billing/collecting for commercial insurance

2 years of experience billing/collecting for Medicare/Medicaid

1 year of experience within denials management process.

Insurance knowledge including basic coding, claims submission, collections, and prior authorization processes,

Familiarity with multiple insurances and their medical policies, professional and facility billing requirements,

Experience and understanding of working with billing reports and aged accounts

Basic understanding of provider credentialing and third party payer contracts,

Familiar with the use of CPT and ICD-9 manuals,

Familiar with UB and HCFA 1500,

Ability to request and research information regarding billing procedures from Medicaid, Commercial and other third party payers.

Employment Status

Full Time

Shift

Days

Equal Employment Opportunity

Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf