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 verification, Data reconciliation, Formal business writing
Preferred skills
Microsoft Excel, Trend analysis, Clinical team interaction
Responsibilities
Interact with clinical teams to obtain facts for medical necessity; Track payment request outcomes; Compile detailed appeal documents; Identify and report payment/denial trends; Create and maintain spreadsheets of open accounts; Reconcile data with plan contacts.
Seniority
Mid-level, individual contributor
