Analyze third-party denial trends and reimbursement issues to identify root causes and recommend corrective actions.
Lead and support appeals initiatives in collaboration with Reimbursement Administrator, including identifying appeal opportunities, tracking outcomes, and collaborating with internal and external teams to improve success rates.
Conduct detailed analyses of data related to existing or proposed revenue cycle projects, including payor performance and denial resolution.
Develop and present findings through graphs, charts, written summaries, and presentations for leadership review.
Collaborate with Revenue Cycle Operations to identify areas for improvement and support the implementation of strategic projects.
Assist in the development and documentation of Standard Operating Procedures (SOPs) for denial management and appeals processes.
Manage the implementation of process improvements across the revenue cycle, ensuring alignment with organizational goals.
Provide timely and accurate updates to management on outstanding denial and appeal trends using defined systems and tracking mechanisms.
Ensure timely follow-up on unresolved issues to minimize business risks and revenue loss.
Stay current with payor guidelines, regulatory changes, and industry best practices related to reimbursement and appeals.

Bachelor’s degree with 7 years’ healthcare revenue cycle environment experience or Associate degree with 9 years healthcare revenue cycle environment experience or HS diploma or GED with 11 years healthcare revenue cycle environment experience
5 or more years experience with payor contracts, medical terminology, commercial and government health insurance, billing guidelines, and appeals processes.
3 or more years experience with SAS, Crystal Reports, Business Objects, or similar platforms
5 or more years Microsoft Excel.

Senior Reimbursement Analyst

Key skills