At SGMC Health, we are dedicated to making our community better through excellence, accountability, and compassionate service. The Denials Management Analyst plays a crucial role in the Revenue Cycle Medical Group by analyzing zero paid, underpaid, overpaid, and denied insurance claims with a thorough understanding of managed care payment methods. Responsibilities include interpreting payer contracts, coordinating with payers and internal departments, reviewing payer contractual adjustments, preparing educational materials, identifying denial trends, and managing appeal or reconsideration processes while adhering to filing deadlines.
The analyst will work closely with patients, clinicians, insurance companies, and regulatory agencies, requiring strong communication and organizational skills. Knowledge of insurance and managed care programs such as Medicare, Medicaid, Tricare, and commercial plans, as well as CPT-4, HCPCS, ICD-10 coding, reimbursement methodologies, and medical terminology are critical. Preference for candidates with a college degree or coursework, CPAR certification, clinical and professional coding background. Technical skills include proficiency with EPIC PB Resolute, Microsoft Office, and ability to type 40 wpm accurately.
Work environment is office-based in a modern, climate-controlled setting with moderate noise levels and occasional overtime. Physical requirements include sitting, standing, walking for moderate periods, and occasional light lifting (0-25 lbs).
Must have extensive knowledge of insurance and managed care programs including Medicare, Medicaid (Georgia), Tricare, VA, and commercial plans. Familiarity with CPT-4, HCPCS, ICD-10 coding. Understanding of reimbursement methodologies: percent of charges, fee-for-service, and fee schedule. Knowledge of patient type, financial class, place of service codes, and relationship codes. Awareness of regulatory requirements such as Medicare Secondary Payer, medical necessity, and appeals. Experience with EPIC PB Resolute and Microsoft Office applications with strong Excel skills. Strong verbal and written communication skills. Organized with effective prioritization abilities. College degree or coursework preferred. CPAR certification preferred. Typing speed of 40 wpm accurately. Clinical background and professional coding experience preferred.
Low healthcare insurance premiums 401(k) with employer match Paid Time Off (PTO) Employee discounts Company paid life insurance Short-Term and Long-Term Disability Cancer Insurance Accident Insurance Pet Insurance Tuition Reimbursement On-the-job training and skills development Opportunities for growth and advancement Employee Assistance Program
Location
Georgia, US
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
No
Posted
1 month ago