The Denial Management Analyst manages disputed or denied claims by analyzing medical records and payer policies to recover reimbursements in a hospital setting. Reviews and responds to payer audits. Ensures accurate ICD-10 coding, analyzes denial and audit trends to identify root causes, and coordinates appeals through documentation, contract reviews, and payer negotiations. The analyst supports process improvements, tracks appeals, and collaborates with clinical and revenue teams to efficiently review and resolve claim denials. Follows payer-specific rules, federal and state regulations, and industry trends under limited supervision.

Highly detail-oriented with advanced organizational and prioritization skills, capable of managing complex and high-priority projects concurrently.

Expert proficiency in Microsoft Word, Excel, PowerPoint, and Outlook.

Exceptional verbal and written communication skills, including drafting high-level memorandums, letters, and official correspondence.

Expert knowledge of hospital billing, appeals processes, and denial management, with the ability to handle complex payer disputes, escalated claims and audits.

In-depth understanding of payer contracts, Medicare/Medicaid guidelines, and audit requirements.

Strong familiarity with industry best practices in revenue cycle management.

Proficient in navigating office software, billing systems, and abstracting tools, with demonstrated expertise in using coding resources.

Advanced understanding of insurance authorizations, benefits, coverage, and eligibility as they relate to medical billing.

Expertise in reimbursement practices and payer-specific requirements, ensuring compliance and optimal reimbursement.

Ability to mentor and guide Tier 1 and Tier 2 billers in billing processes and denial resolutions.

Expertise in conducting root cause analysis and providing solutions to recurring billing issues.

Stay current on payer-specific guidelines, industry trends, and regulatory requirements to ensure compliance and billing efficiency.

Education: Associate's degree in a related field required.

Responsibilities include reviewing denied claims, responding to payer audits with medical documentation, preparing and submitting appeals, analyzing trends for process improvement, verifying coding accuracy (ICD-10, CPT, HCPCS), contract review, negotiating resolutions, tracking appeals and outcomes, supporting process improvement, educating staff, stakeholder collaboration, maintaining confidentiality, handling high-level appeals and escalated claims, conducting root cause analysis, and other duties assigned by supervisor or manager.