Claims Analyst - Hospice Denials Management

Job Summary:

We are seeking a detail-oriented and experienced Insurance Denials Management Specialist to join our team, specializing in hospice claims. The ideal candidate will have a strong background in analyzing, appealing, and resolving insurance denials to optimize reimbursement and ensure compliance with hospice care billing regulations.

Key Responsibilities:

• Review, analyze, and manage insurance claim denials specifically related to hospice care services.
• Identify root causes of claim denials and develop effective strategies for appeal and resolution.
• Prepare and submit timely and accurate appeals to insurance payers, including Medicare, Medicaid, and private insurers.
• Collaborate closely with billing, clinical, and coding teams to ensure accurate documentation and coding compliance for hospice claims.
• Monitor denial trends and report findings to management to improve revenue cycle processes.
• Maintain up-to-date knowledge of hospice billing regulations, payer policies, and industry best practices.
• Track and document all denial management activities in the appropriate systems.
• Communicate effectively with insurance companies, internal departments, and external providers to expedite claim resolutions.
• Assist in training staff on hospice-specific denials management processes and requirements.
• Contribute to process improvement initiatives to reduce denial rates and accelerate payment cycles.

Qualifications:

• Minimum of 2 years experience in insurance denials management with a focus on hospice claims.
• In-depth understanding of hospice billing, coding (including ICD-10, CPT, and HCPCS), and regulatory requirements.
• Familiarity with Medicare Hospice Benefit and payer-specific policies.
• Strong analytical and problem-solving skills.
• Excellent written and verbal communication skills.
• Proficient in denial management software, billing systems, and MS Office applications.
• Ability to work independently and as part of a team in a fast-paced environment.
• Detail-oriented with strong organizational skills.

Preferred:

• Certification in Medical Billing, Coding, or Revenue Cycle Management (e.g., CPC, CPB) a plus.
• Experience working with electronic health record (EHR) systems and hospice-specific billing platforms.
• Knowledge of compliance and audit requirements related to hospice care claims.