Denials Prevention Analyst - (Middletown, OH)

Job summary: Primarily responsible for thorough review of managed care contracts and comparison of such contracts against denied healthcare claims to identify underpayments for the assigned client. Essential Duties and Responsibilities: Research commercial and governmental payor policies, clinical abstracts and studies, and other documentation related to claims payment to evaluate and appeal denied claims Examine claims and calculate reimbursement based on contract terms to determine accuracy of payment through use of various reports and supporting documentation Review insurance contracts to gain thorough understanding of payment methodologies Contact insurance company to obtain missing info, explain and resolve denials and arrange for payment or adjustment processing on behalf of client Follow up on claims in a timely fashion as outlined in BLS and/or departmental policies and procedures Document info in appropriate BLS and client systems Prepare and submit correspondence such as letters, emails