Research Denial Prevention Specialist

JOB SUMMARY

This Research and Analysis position is responsible for ensuring claims and denials are efficiently and effectively functioning and assess Operational Processes for risks in the Revenue Cycle that lead to Denials and Write-offs. The Denials Researcher will be the main conduit for identifying opportunity for the Denial Prevention and Operations teams to facilitate continuous improvement. Revenue Cycle wide knowledge is needed to assess and optimize Scheduling, Financial Clearance, Clinical Care Management, Coding, Billing, Follow Up and Appeal processes are working effectively and efficiently to reduce denial write offs

Critical responsibilities include: (a) providing research and analysis findings to support Denial Prevention to assess training and process needs in the Markets and Business Office processes, (b) Review and analyze claim denials, providing root cause trending to Denial Prevention and Operations; and (c) Review Key Performance Indicators by practice against research findings

ESSENTIAL DUTIES AND RESPONSIBILITIES

Include the following. Others may be assigned.

• Denial Research -- Serve as primary conduit for analyzing denial data, operational processes, and accounts that fall out, leading to Denials and Revenue Loss. Assess and monitor Operational processes that contribute to Denials, providing data trending, processes observations, and level remediation feedback to Denial Prevention. Interacts with Denials Management and other key sponsors, presents a knowledgeable, efficient, and professional image by handling business in a respectful and professional demeanor, and excel in the following activities: 
  • Company Advisor – Rise to the level of trusted advisor within Conifer, with an eye on performance.
  • Reporting and Analytics– Prepare and present to Operational performance trending, gaps, and next steps as appropriate 
  • Relationship Management -- Facilitate and maintain relationships through regular, pro-active communication, timely follow-through on requests and coordination of resources to meet Conifer needs
• Effectively communicate data or technical concepts with detail to Prevention and Operations. Strong proficiency with Excel, Access, PowerPoint along with superior Verbal and written communication skills. 
• Ability to review and churn through a large number of accounts, identifying the critical areas of focus over non-impactful misses for prioritization and focus. Identify any emerging analytic needs for stakeholders to monitor impact and process gaps. 
• Defining issues; identifying root causes; interpreting data; understanding data dependencies; goal setting; establishing tracking and reporting metrics; updating project plans; leader of denial subcommittees; providing performance reports and deliverable preparation
• As needed, provide project management support, analysis, and/or technical expertise for a broad array of Revenue Cycle initiatives. Has responsibility for assisting teams in support of Regional or National Analysis and Research
• Company Policy. Adheres to all company policies and procedures including, but not limited to those identified within the Standards of Business Conduct and the Employee Handbook, as may be amended from time to time. Adheres to all applicable laws and regulations and the company's governance/compliance program. Responsible for reporting violations of the company's policies and procedures, Standards of Business Conduct, Compliance, governance program, laws and regulations through the company's Help Line or other mechanism that may be available at the time of the violation. Assists with internal control failure remediation efforts. Relationship Management -- Facilitate and maintain relationships through regular, pro-active communication, timely follow-through on requests and coordination of resources to meet client needs

KNOWLEDGE, SKILLS, ABILITIES

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Requires an understanding of systems and processes that impact revenue cycle performance and capabilities. 
• Possesses the ability to build trusting relationships with Operational Leaders
• Possesses analytical ability sufficient to work in a data-heavy environment and to identify trends in the data.
• Possess business acumen with an emphasis on research and then soft skills, such as effective communication, problem solving, decision making and time management skills.
• Intermediate MS Office required (Outlook, Excel, Word, and PowerPoint).