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Description

Become part of an inclusive organization with over 40,000 teammates, whose mission is to improve the health and well-being of the unique communities we serve.

About the position

The Denials Prevention Analyst plays a crucial role in identifying and mitigating denial risks for both acute and ambulatory claims within the healthcare revenue cycle. This position involves analyzing clinical and technical denials, collaborating with various departments, and developing strategies to reduce denials through effective reporting and training initiatives. The analyst will work closely with stakeholders to implement sustainable measures that address the root causes of denials, ensuring compliance with billing regulations and optimizing revenue capture.

Responsibilities

• Perform root cause analysis on denied accounts to identify high dollar and high-volume denials.

• Identify trends impacting payment optimization and collaborate with internal and external departments to decrease system-wide denials.

• Review adjustments based on Denial Write-Off Approval Levels, providing feedback to users.

• Establish and monitor key performance indicators, developing standardized reporting and presenting denial reports to leadership.

• Evaluate denial appeal practices and educate on best practices for responding to denials, ensuring necessary documentation is included.

• Participate in Denial Committee, focusing on denial prevention activities and performance improvement.

• Compile monthly reports and dashboards on avoidable write-offs, monitoring key performance indicators for performance improvement activities.

• Partner with Managed Care to ensure adherence to contracts and communicate updates on billing guidelines and payment policies.

• Identify and track areas of revenue leakage, submitting corrected claims and tracking for additional payment.

• Collaborate with the Denials Management Team to provide information for resolving denials and create educational materials on process improvements.

• Demonstrate understanding of federal, state, and third-party charging guidelines, analyzing revisions to coding and billing regulations.

• Participate in in-services and organizational meetings, utilizing lean management tools and continuing education programs.

Requirements

• An associate degree in a related field or 5+ years of relevant experience.

• Three (3)+ years of denial experience with commercial and government payer types for both professional and facility claims.

• Knowledge of regulatory, compliance, and reimbursement methodologies.

• Ability to research and interpret Federal, State, and Local billing regulations.

• Demonstrated ability to navigate payer websites and understand billing requirements.

• Ability to present data and complex information effectively to various audiences.

• Excellent organizational and time management skills; detail-oriented and self-directed.

• Strong computer skills, including report and dashboard creation using Word, PowerPoint, and Excel.

• Strong interpersonal, critical thinking, and communication skills.

• Strong problem-solving, research, and analytical skills.

• Knowledge of CPT/APC/HCPCS and ICD/DRG coding and reimbursement concepts.

• Positive service-oriented communication skills.

Qualified applicants will be considered without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, status as a protected veteran or political affiliation.

Qualified applicants will be considered without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.