Claims Denials Management & Resolution Analyst

OverviewThe 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.ResponsibilitiesClaim 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.Handle 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.Perform an in-depth review of documentation and present findings along with recommendations to the department on needed education. The position directly impacts hospital and physician reimbursement.Act to secure reimbursement and minimize organizational write-offs.Familiarity with all applicable billing and coding regulations and the ability to communicate these regulations to all levels of faculty, management, and staff. Assign codes based on review of clinical charts, resolve coding issues based on denials, and identify areas of improvement.QualificationsBachelor'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/NCDs, state and federal regulations as well as payor billing requirements.Knowledge of medical terminology, anatomy, and physiology.License/CertificationCertified Professional Coder in good standing with AAPC, and maintain yearly credits to ensure certification.Department Description / About UCSFMedical 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.Equal Employment OpportunityThe 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.LocationEmeryville, CAEmployment typeFull-time #J-18808-Ljbffr

Created: 2025-09-17