Exciting Opportunity: Join Nebraska Methodist Health System as a Denials Management Analyst!
Join the dedicated team at Nebraska Methodist Health System as a Denials Management Analyst and enjoy a fulfilling career with excellent work-life balance. In this role, you will be responsible for the meticulous review of denials for both commercial and government payers, managing physician and facility claims, and escalating appeals to ensure maximum reimbursement in compliance with payer contracts and CMS regulations. At Nebraska Methodist Health System, we pride ourselves on our supportive company culture, where your professional growth and personal well-being are our top priorities.
Job Duties & Responsibilities:
- Analyze denials against contracts, payer policies, NMHS coding, and authorization processes.
- Verify payment accuracy, initiate corrective actions with payers, and understand contract and reimbursement language.
- Maintain follow-up and reporting systems for reimbursement receipt.
- Research and resolve contractual and reimbursement issues, ensuring correct denial handling and timely follow-up on denials and appeals.
- Assist staff with work volume, respond to special requests accurately, and provide contract/payor recommendations.
- Participate in payer meetings, escalate payer issues, and track agenda issues.
- Provide training on contracts and reimbursement to other areas as needed.
Schedule:
- Monday-Friday, 8am-4:30pm
Location:
- Methodist Corporate Office- 825 S 169th St, Omaha, NE
Salary:
- $18.15-$29.05, based on work history/experience
Job Qualifications:
- High School Diploma or General Educational Development (G.E.D.) required.
- College coursework in accounting and or health care preferred.
- Minimum 1-2 years experience with a 3rd party payer or healthcare provider required; 1 year of insurance billing preferred.
- Six months of experience with Institutional and Professional ICD/CPT coding, DRG reimbursement, and outpatient reimbursement including ASC grouper and ER preferred.
- Proficiency with Microsoft Office (Word, Excel, Outlook), 10-key data entry, and strong verbal and written communication skills.
- Knowledge of medical terminology, patient accounting software, payer websites, UB/HCFA billing formats, ICD, CPT, Revenue Codes, DRG methodology, CMS regulations, and WPS ANSI remark codes.
- Ability to read and interpret payer Explanation of Benefits (EOB), apply basic accounting and math principles, and analyze data trends.
About Methodist:
Methodist Health System named by Forbes in 2024 as "Nebraska's Best Employer" and "Best Employer for New Graduates"
Nebraska Methodist Health System is made up of four hospitals in Nebraska and southwest Iowa, more than 30 clinic locations, a nursing and allied health college, and a medical supply distributorship and central laundry facility. From the day Methodist Hospital was chartered in 1891, service to our communities has been a top priority. Financial assistance, health education, outreach to our diverse communities and populations, and other community benefit activities have always been central to our mission.
Nebraska Methodist Health System is an Affirmative Action/Equal Opportunity Employer and does not discriminate on the basis of race, color, religion, sex, age, national origin, disability, veteran status, sexual orientation, gender identity, or any other classification protected by Federal, state or local law.
