Hospital - Denial Management Analyst

Job description

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. Review Denied Claims: Analyze denied insurance claims to determine the root cause of denials and identify corrective actions. Respond to Payer Audits: Prepare and submit required documentation, including medical records, for payer-requested audits and prepayment reviews. Appeal Denials: Develop and submit appeals using medical records, appeal letters, and other supporting documentation to recover denied revenue. Trend Analysis: Analyze denial and audit trends to identify patterns and recommend process improvements to reduce future denials. Verify Codi...