GIRMC Insurance Denials Analyst in Lincoln, Nebraska at Bryan Health

GENERAL SUMMARY:

Analyzes payer denials and payment variances to ensure accurate reimbursement and compliance with payer and regulatory requirements. Identifies root causes of denials, prepares and submits appeals, and collaborates with internal and external stakeholders to resolve discrepancies. Monitors trends, communicates findings, and supports process improvements to reduce denials and optimize revenue recovery. Uses data analysis and contract knowledge to strengthen reimbursement outcomes and maintain financial integrity.

PRINCIPAL JOB FUNCTIONS:

1. *Commits to the mission, vision, beliefs and consistently demonstrates our core values.

1. *Analyzes payer denials, payment variances, and underpayments to identify root causes and resolve discrepancies.

1. *Prepares, submits, and tracks appeals to ensure timely and appropriate reimbursement recovery.

1. *Reviews payer contracts and reimbursement methodologies to validate expected payment accuracy.

1. *Monitors denial trends and develops reports to support performance tracking and improvement efforts.

1. *Communicates findings and recommendations to leadership, revenue cycle teams, and stakeholders.

1. *Collaborates with internal departments and payers to resolve billing issues and prevent recurring denials.

1. *Supports audits and participates in payer review activities to ensure compliance and accuracy.

1. *Identifies opportunities to improve billing processes and reduce denial volume.

1. *Maintains current knowledge of payer requirements, reimbursement methodologies, and regulatory changes.

1. Maintains professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest trends in field of expertise.

1. Participates in meetings, committees and department projects as assigned.

1. Performs other related projects and duties as assigned.

(Essential Job functions are marked with an asterisk “*”).

REQUIRED KNOWLEDGE, SKILLS AND ABILITIES:

1. Knowledge of third party payer (Medicare, Medicaid, insurance) pre-admission, admission and discharge guidelines, including billing requirements.

1. Knowledge of third party requirements for appeal and reconsiderations.

1. Knowledge of billing and accounts receivable management, including CPT coding, ICD-10 coding, revenue coding, DRG coding, APC coding, and EAPG reimbursement methodologies.

1. Knowledge of regulatory agencies and corporate compliance requirements related to reimbursement.

1. Knowledge of computer hardware equipment and software applications relevant to work functions.

1. Knowledge of hospital managed care contracts, contract implementation standards and schedules.

1. Ability to analyze problems, identify needs and priorities and implement effective work strategies and process efficiencies.

1. Ability to collect, compare, sort and prioritize information to be used in analysis processes.

1. Ability to prioritize work demands and work with minimal supervision.

1. Ability to communicate effectively both verbally and in writing.

1. Ability to consistently meet predetermined deadlines.

1. Ability to establish and maintain effective working relationships with all levels of personnel, medical staff, ancillary departments and vendor representatives.

1. Ability to maintain confidentiality relevant to sensitive information.

1. Ability to maintain regular and punctual attendance.

EDUCATION AND EXPERIENCE:

High school diploma or equivalent required. One (1) year of college coursework in accounting, coding, insurance or related field required.

PHYSICAL REQUIREMENTS:

(Physical Requirements are based on federal criteria and assigned by Human Resources upon review of the Principal Job Functions.)

(DOT) – Characterized as sedentary work requiring exertion up to 10 pounds of force occasionally and/or a negligible amount of force frequently to lift, carry, push, pull, or otherwise move objects, including the human body.