Denials/Appeal Analyst
Johns Hopkins Health System
Baltimore, Maryland
2015 - Current
- Correct billing and claim resubmission to all carriers including Medicare and Medicaid
- Review denials for accuracy and determine the correct root cause of the denial
- Create graphs and reporting summary sheets for senior staff and directors to review monthly
- Analyzed data and developed reports/presentations that supported informed decision making to enhance revenue cycle performance and maximize operational efficiencies routinely presented updates and finding to Executive Leadership
- Manage relationships with administrators, physicians, clinic mangers, information technology/electronic medical record partners, and Revenue Cycle Management leaders to ensure all stakeholders are aligned to meet Patient Access performance goals and targets
- Formulates action plans for denial resolution in conjunction with various departments including (both internal and external) with key professionals
- Assist in training and creating training materials for new staff
- Write professional appeals in response to denied claims or payer audit request
- Identifies and communicates trends
- Provides claims review and interpretation of appropriateness of administrative appeal
- Ensures the quality and organization of administrative appeal documentation
- Responsible for the preparation and research of data and records required to assure timely processing of appeals
- Responds to, documents, investigates and facilitates the resolution of provider administrative appeals, including the writing, review, and approval of resolution letters.
