Claim Denial Analyst

Job Title & Specialty Area: Claim Denial Analyst

Department: Revenue Cycle Administrative

Location: Dallas, TX

Shift: Monday - Friday

Job Type: Remote in Texas only

Why Children's Health?
At Children's Health, our mission is to Make Life Better for Children, and we recognize that their health plays a crucial role in achieving this goal.

Through our cutting-edge treatments and affiliation with UT Southwestern, we strive to deliver an extraordinary patient and family experience, ensuring that every moment, big or small, contributes to their overall well-being.

Our dedication to promoting children's health extends beyond our organization and encompasses the broader community. Together, we can make a significant difference in the lives of children and contribute to a brighter and healthier future for all.

Summary:
Supports claims denials reductions and increased revenues through process re-design, root cause analysis, metric/report development and special projects related to claim denials and underpayments. Prepares denial data to support all internal projects, documents root cause data, identify denial/revenue trends, and follows up on escalated issues until closing of project.

Responsibilities:

• Serve as a claim denial subject matter liaison between operations and other departments to identify issues and optimize resolution.
• Develop, implement and/or recommend claim denial root cause reporting as appropriate. Perform quality control for data related to denials/underpayment of reimbursement by interpreting payer agreements, claims, and payer policy and procedures.
• Identifies, tracks, analyzes and researches frequent root causes of claim denials in Epic and department system and develops corrective action plans for resolution of denials
• Demonstrated ability to perform denial root cause analysis, draw conclusions, review process workflows, and prepare for Denial Management Director and Manager review
• Develop and maintain an effective relationship with internal customers. Work with the billing team to provide root cause analysis for all problem claims.
• Provide frequent project updates to Manager
• Develop detailed reports to support performance and strategic business initiatives
• Keep abreast of all payor updates, expected reimbursement process and bulletins, including contacting payers to obtain additional information related to the denial.
• Ensure all escalated issues are addressed and reported.
• Process account information and a variety of other forms of documents by resolving inconsistencies and reviewing data for errors using the Billing Department's standard billing and data entry policies and procedures.
• Perform other duties as assigned or required.
• Actively participate in denial review department meetings and multi-department workgroups by providing detailed insight into denial causes.

How You'll Be Successful:

Other information:
WORK EXPERIENCE

• At least 5 years health care experience in Patient Access and/or Patient Financial Services Required
• At least 5 years Epic experience in patient access, health care billing, claims and/or denial management. Required
• Demonstrated proficiency in relevant software applications, including Microsoft Word, PowerPoint and Excel Required

EDUCATION
Two-year associate's degree or equivalent experience Required

LICENSES AND CERTIFICATIONS
CHAA - Certified Healthcare Access Associate Preferred

A Place Where You Belong

We put our people first. We welcome, value, and respect the beliefs, identities and experiences of our patients and colleagues. We are committed to delivering culturally effective care, creating meaningful partnerships in the communities we serve, and equipping and developing our team members to make Children's Health a place where everyone can contribute.

Holistic Benefits - How We'll Care for You:
• Employee portion of medical plan premiums are covered after 3 years.
• 4%-10% employee savings plan match based on tenure
• Paid Parental Leave (up to 12 weeks)
• Caregiver Leave
• Adoption and surrogacy reimbursement

As an equal opportunity employer, Children's Health does not discriminate against employees or applicants because of race, color, religion, sex, gender identity and expression, sexual orientation, age, national origin, veteran or military status, disability, or genetic information or any other Federal or State legally-protected status or class. This applies to all aspects of the employer-employee relationship including but not limited to recruitment, hiring, promotion, transfer pay, training, discipline, workforce adjustments, termination, employee benefits, and any other employment-related activity.