Natividad is currently seeking to fill a full time permanent Management Analyst III in our Finance Department. This position provides administrative and operational support to the Revenue Cycle Team. This position is responsible for tasks related to denials management and patient account management. The analyst ensures timely and accurate data entry, supports communication with insurance providers and revenue cycle team, and helps maintain compliance with regulations and policies.

THE SIGNIFICANT DUTIES OF THE POSITION ARE AS FOLLOWS:

• Assist in the preparation and submission of appeals. Mail appeal correspondence, confirm receipt/portal check.
• Process and track claim denials, including coordinating with clinical staff for additional documentation; Monitor accounts and track outstanding appeals for payment.
• Track final determination and communicate to Appeals Specialist (RN); Obtain copies of NOA (Notices of Action), and relevant decision letters; Conduct timely follow-up on pending appeals and denials to ensure resolution.
• Verify and update insurance information in the system; Monitor account aging and identify accounts requiring immediate attention.
• Update patient accounts with appeal outcomes and payment adjustments; Process claim resubmissions and corrections as needed.
• Respond to inquiries regarding appeal status from internal and external stakeholders.
• Collaborate with other departments to resolve account discrepancies; Coordinate with clinical staff to obtain necessary documentation for appeals.
• Maintain regular communication with payers regarding claim status.
• Assist in generating reports for management regarding denials and appeals metrics.
• Track and analyze denial patterns to identify improvement opportunities; Maintain accurate up-to-date denial and appeal records.
• Prepare monthly summaries of appeal outcomes and success rates; Monitor key performance indicators related to denials management.
• Ensure compliance with HIPAA and other relevant regulations; Follow established policies and procedures for handling protected health information.
• Maintain current knowledge of payer policies and requirements; Participate in regular training and education sessions.
• Assist in implementing process improvements for denial prevention.

MINIMUM QUALIFICATIONS

Thorough knowledge of:

• Principles and practices of management and financial accounting.
• Principles of mathematical and statistical analysis, preparation and presentation.
• Research techniques.
• Principles and practices of public and/or business administration.
• Report writing.
• Internal and external operations, functions and resources related to the assignment.

Skill and Ability to:

• Develop and provides analytical and financial services.
• Analyze and interpret a wide variety of complex data and information.
• Conduct comprehensive and in-depth research.
• Identify issues, options and projected outcomes and make recommendations.
• Prepare and present written and oral reports.
• Interpret and apply codes, regulations, laws policies, procedures and guidelines
• Coordinate a wide variety of activities.
• Work independently and in a timely fashion
• Communicate effectively orally and in writing
• Provide direction to others on projects and activities
• Work cooperatively and tactfully with others