Insurance Communication Analyst
St. Jude Children's Research Hospital - Memphis, TN

This job posting is no longer available on St. Jude Children's Research Hospital. Find similar jobs: Insurance Communication Analyst jobs

The Insurance Communication Analyst in the Managed Care Department under the direction of the Manager, Insurance Communications provides clinical and administrative expertise to the appeal function. Creates strategy for addressing specific claim denials. Works cooperatively with patient's families, departments throughout the hospital and with physicians and their office staff to assure the creation and timely submission of a persuasive, technical, and accurate appeal document. Works effectively with all payor representatives. Demonstrates flexibility and creativity in the function. Represents the department in all appeal activities. Maintains data on all appeals and their outcomes. Creates, augments and maintains files of resources on legislation, state or payor initiatives and supportive arguments to be utilized in refuting denials. Demonstrates significant success in reversing third party payor denials as measured by pre-determined performance requirements. Creates, on a routine basis, all Managed Care downloads and appeal reports. Drafts policies and procedures on this subject. Works with any consulting firms and other departments to maximize recovery of denials. Completes national centers of excellence surveys for transplant and oncology. (CB)

Job Qualifications:

EDUCATIONAL REQUIREMENTS :

Bachelor's degree in a health-related field, RHIA or RN preferred.

Master's degree preferably in a clinical or research field strongly preferred.

Two (2) additional years of related work experience may be substituted by the Master's degree.

EXPERIENCE REQUIREMENTS :

A minimum of three (3) years’ experience working in a medical or health insurance plan setting is required.

LICENSURE REQUIREMENTS :

None

OTHER CREDENTIALS :

RN, RHIA or similar licensure preferred.

Apply Now

St. Jude Children's Research Hospital - 17 months ago - save job - copy to clipboard - block
Recommended Jobs
Financial Analyst Risk Management
International Paper Company - Memphis, TN
International Paper Company - 12 days ago

Contract Analyst
Accredo Health Group, Inc - Memphis, TN
CareersInPharmaceutical.com - 26 days ago

Programmer Analyst
Hub Group Trucking - Memphis, TN
Hub Group Trucking - 30+ days ago
About this company
58 reviews
St. Jude Children's Research Hospital studies and treats catastrophic diseases in children, especially pediatric cancers. The hospital,...