HCA, Hospital Corporation of America Prebill Analyst in Houston, Texas

Prebill Denials Analyst Job Summary – The Prebill Denials Analyst will review post discharge, prebill accounts that do not have an authorization on file, ALOS versus days authorized variances, and/or other account discrepancies identified that will result in the account being denied by the payor that do not require a clinical review. Communicates with third party payors to resolve discrepancies prior to billing. Accurately and concisely documents all communications and action taken on the account in accordance with policies and procedures. The Prebill Denials Analyst will escalate medical review request and/or denial activities to the Prebill Denials Nurse. Supervisor – Denials Director Supervises – N/A Functional areas:

  • Verification of authorization on services post discharge, prebill

  • Validating re-certification for additional days post discharge, prebill

  • eRequest queues as determined during program implementation Duties (included but not limited to):

  • Work prebill accounts identified via the Meditech reports efficiently and effectively on a daily basis to resolve

  • accounts with “no auth numbers and ALOS vs. authorized days variances

  • Work assigned accounts in eRequest to resolve outstanding issues

  • Report insurance denial trends identified during daily operational assignments

  • Identify problem accounts and escalate as appropriate

  • Document actions taken on the account clearly and concisely

  • Contacting the facilities, physicians’ offices and/or insurance companies to resolve denials/appeals

  • Adhere to time and attendance policies

  • Adhere to all policies and procedures, including phone and internet usage, break utilization, etc.

  • Participate in ongoing education and training as needed

  • Establish and maintain relationships with all customers

  • Seeks assistance from immediate supervisor when in situations which are unclear or ambiguous

  • Adheres to established policy and procedure and escalates issues through the established Chain of Command

  • Demonstrates commitment to teamwork and cooperation

  • Practice and adhere to the “Code of Conduct” philosophy and “Mission and Value Statement”

  • Other duties as assigned

Knowledge, Skills & Abilities

  • Customer Orientation– establishes and maintains long term customer relationships, building trust and respect by consistently meeting and exceeding expectations

  • Communication- communicates professionally, clearly and concisely

  • Interpersonal skills –ability to establish and maintain collaborative and effective working relationships

  • PC Skills– demonstrates advanced proficiency in Microsoft Office applications and others data mining software

  • Policies & Procedures -demonstrates knowledge and understanding of organizational policies, procedures and systems

  • Basic skills– demonstrates ability to organize, perform and track multiple tasks accurately in short timeframes and have ability to work quickly and accurately in a fast-paced environment while managing multiple demands EXPERIENCE

  • Revenue Cycle operational experience in the following areas: appeals, denials, managed care,

  • verifications/notification, precertification experienced preferred CERTIFICATE/LICENSE – N/A PHYSICAL DEMANDS/WORKING CONDITIONS –Requires prolonged sitting, some bending, stooping and stretching. Requires eye-hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator and other office equipment. Requires normal range of hearing and eyesight to record, prepare and communicate appropriate reports. Requires lifting papers or boxes up to 25 pounds occasionally. Work is an office environment. Work may be stressful at times. Contact may involve dealing with angry or upset people. Staff must remain flexible and available to provide staffing assistance for any/all disaster or emergency situations. OSHA CATEGORY –The normal work routine involves no exposure to blood, body fluids, or tissues (although situations can be imagined or hypothesized under which anyone, anywhere, might encounter potential exposure to body fluids). Persons who perform these duties are not called upon as part of their employment to perform or assist in emergency care or first aid, or to be potentially exposed in some other way.

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Job: *Finance Acctg Billing Claims & Revenue

Title: Prebill Analyst

Location: Texas-Houston-Prebill Denial – Houston

Requisition ID: 26515-135636