Managed Care Revenue Optimization Analyst - FT - Days - MSS - Hybrid Eligible
Core
Reviews and analyzes insurance denials and short payments to determine resolution plans and obtain payment in accordance with contracts and laws.
Role type
Managed Care Revenue Optimization Analyst
Builds
Payment collections and appeal documentation for hospital services
Domain
Healthcare / Managed Care Insurance
Deliverable
client delivery
Required skills
Managed care claims processing, Billing and coding knowledge, Federal and state regulations, Medical necessity assessment, Data reconciliation, Trend analysis
Preferred skills
Microsoft Excel, Formal business communication
Responsibilities
Review and analyze denials and short payments; Compile detailed written appeal documents; Track outcomes of payment requests; Reconcile business systems and reports; Interact with clinical teams for medical necessity facts; Identify and report payment and denial trends.
Seniority
Mid-level, independent decision maker