Insurance Claims Analyst / Revenue Cycle in Dickson, Tennessee at Dickson Medical Associates, PC

SUMMARY: Under the direction of the Credit/Collections Manager, the Insurance Claims Analyst is a vital revenue cycle role responsible for investigating, appealing, and resolving unpaid, rejected, and denied insurance claims. This position works closely with commercial payers, Medicare, and Medicaid to recover rightful revenue, identify root causes of billing errors, and ensure optimal reimbursement compliance for our medical practice.

KEY RESPONSIBILITIES (Duties include the following, but are not limited to)

• Denial & Rejection Management:
  • Review, categorize, and work daily electronic and paper denial reports across commercial payers, Medicare, and managed care plans.
  • Investigate the root causes of claim rejections and denials (e.g., coding errors, missing prior authorizations, timely filing limits, eligibility issues).
• Claims Follow-Up & Appeals:
  • Actively follow up on aging accounts receivable (A/R) and unpaid claims past standard processing windows via payer portals, phone, and written correspondence.
  • Draft, compile, and submit formal clinical and administrative appeals for denied claims, attaching necessary medical records, provider notes, and supporting documentation.
• Payer & Clearinghouse Coordination:
  • Communicate directly with insurance representatives, case managers, and payer adjudication departments to resolve complex claims disputes.
  • Monitor clearinghouse error logs and correct/resubmit claims promptly.
• Process Improvement & Root Cause Analysis:
  • Track denial trends by payer, provider, and denial code, reporting recurring billing bottlenecks to the billing management team.
  • Collaborate with front-desk, registration, and clinical coding teams to implement preventative measures and reduce upfront claim errors.
• Compliance & Documentation:
  • Maintain accurate, up-to-date notes within the EPIC Practice Management (PM) / Electronic Health Record (EHR) system regarding all collection and appeal efforts.
  • Ensure all follow-up and appeal activities adhere strictly to HIPAA guidelines, payer contracts, and federal/state billing regulations.

QUALIFICATIONS & SKILLS:

Experience: Minimum of 2–3 years of experience in medical billing, medical collections, or revenue cycle management within a physician practice or outpatient clinic setting.

Knowledge Base: Strong working knowledge of medical billing terminology, CPT/HCPCS codes, ICD-10 diagnosis coding, and modifiers. Familiarity with Medicare, Medicaid, and major commercial payer guidelines.

Technical Skills: Proficiency in medical Practice Management software, electronic health records (EHR), and clearinghouse portals. EPIC experience is a plus.

Soft Skills: Exceptional attention to detail, strong analytical and problem-solving abilities, and excellent verbal and written communication skills for dealing with insurance representatives and internal staff.

Education

* High school diploma or equivalent required

* Certified Professional Biller (CPB) or Certified Coding Specialist (CCS) credentials are a plus.

PHYSICAL DEMANDS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions.

While performing the duties of this job, the employee is regularly required to stand; walk; sit; use hands to finger, handle, or feel objects, tools, or controls; reach with hands and arms; and talk or hear. The employee is occasionally required to stoop, kneel, crouch, or crawl.

The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.