Denial Prevention Analyst Senior

Department:

10502 Enterprise Revenue Cycle - Facility Denial Management

Status:

Full time

Benefits Eligible:

Yes

Hours Per Week:

40

Schedule Details/Additional Information:

Monday - Friday 8a-5p

Major Responsibilities:

• Applying high level problem-solving skills, the analyst will perform root cause analysis across large volumes of denials data in order to seek insight on areas of interest
• Evaluates and maintains the proper level of data integrity within the denial mitigations databases.
• Supporting claims denials reductions and increased revenues through process redesign, root cause analysis, and development of metrics and reports.
• Provides expert interpretation of business functions as they impact all system facilities related to governmental and non-governmental denial management processes
• Tracks and analyzes denial data to identify, recommend, and implement opportunities to secure legitimate revenue for the organization.  Identifies trends or patterns that impact payment optimization, and collaborates with departments to establish action plans, initiatives, and policies to reverse negative denial patterns.
• Analyzes and reviews third party payer denial of medical claims and develops and executes strategies to decrease denials system wide to optimize revenue.
• Researches and analyzes applicable regulatory, coding and billing rules and educates departments on regulations, processes, and medical necessity requirements.  Analyzes trends and inefficiencies in medical center charges and recommends suitable operational improvements in an effort to prevent incorrect payments and denials.
• Identifies revenue opportunities and provides appropriate investigation, follow up and resolution. Implements plans and partners with Managed Care Contracting to ensure proper adherence to contracts that does not affect revenue generation.
• Develops, generates, and audits various revenue, financial, statistical and/or quality reports surrounding the denial prevention area of focus.

Education/Experience Required:

• Bachelor's Degree or equivalent knowledge. Finance, Healthcare Finance, Accounting, Audit or related field. Typically requires 7 years of experience in medical billing, healthcare finance, accounting, internal audit and/or coding that includes experience in identifying problems and opportunities for improved workflows, developing processes and procedures to reduce denials, and consulting with leadership on complex denial issues.

Knowledge, Skills & Abilities Required:

• In-depth knowledge of and extensive experience with medical center reimbursement procedures, revenue cycle processes, health insurance, claims coding, and related State, Federal, and Medicare regulations.
• Demonstrated ability to analyze complex data and perform extensive audits to identify problems, trends, and potential risk/compliance issues.
• Ability to communicate with key executive stakeholders, system-wide, at both institutional and corporate levels.
• Skills and experience in successfully leading a functional team and training staff on processes and procedures.
• Demonstrated ability to work collaboratively with other departments and external organizations.
• Excellent written and verbal communication skills and the ability to communicate effectively with all levels of employees and management.  Ability to effectively address difficult and controversial issues.
• Strong analytic, time management and organizational skills, with a high attention to detail.
• Demonstrated proficiency in the Microsoft Office Suite (Word, Excel, PowerPoint) or similar products and knowledge of electronic health.
• Serve as liaison to department administration, physicians, clinic administration, information services, business offices, financial offices, and other stakeholder departments.

​Physical Requirements and Working Conditions:

• This position requires travel, therefore, will be exposed to weather and road conditions.
• Operates all equipment necessary to perform the job.
• Exposed to a normal office environment.

This job description indicate