DENIAL PREVENTION ANALYST

JOB SUMMARY
Under general supervision of the Denial Prevention Program Manager, this position is responsible for denial data research, analytics, issue trending, issue tracking, and coordination of denial prevention activities. The Denial Prevention Analyst will work with all functional areas within the revenue cycle (Patient Access, HIM/Coding, Revenue Integrity, Billing) and hospital departments to better understand the data, processes, and technology and help educate these groups to avoid future denials.

The Denial Prevention Analyst will leverage payer denial, denial write-offs, and appeals data to analyze root causes and share findings with the appropriate leaders to support changes that contribute to reduction in future denial and denial write-offs. This position will be responsible to understand all payer contracts, reimbursement models, and state/federal guidelines to facilitate denial prevention activities.

Daily activities include developing and analyzing reports to monitor and trend denial issues. Establishing and participating in meetings to discuss denial management & prevention activities. Documenting issues and developing solutions to improve the denials prevention processes.

LOCATION

REMOTE

HOURS

Monday through Friday - Days

ESSENTIAL FUNCTIONS

• Assist in preparation professional monthly denial reports / presentations for leadership
• Prepare a denials prevention newsletter no less than quarterly
• Provide excellent customer service, resources, and responsiveness to enterprise needs as they relate to denial prevention activities and be a SlicerDicer resource
• Communicate concerns or issues on behalf of the department in relation to denial prevention performance, with the goal to expedite solutions and financial improvement
• Facilitate effective goal-orientated communication between revenue cycle and clinical department leadership
• Participates in enterprise and hospital-based meetings as needed
• Helps educate leadership, management, and staff on prevention of denials.
• Monitor Denials Prevention Tracking dashboard
• Collaborate with operation, financial and IT leaders to develop solutions and validate implementation.
• Ability to multitask and leverage organizational / analytic skills to perform the most efficient appeals processing

KNOWLEDGE

• Requires an understanding of health insurance coverage and payment regulations.
• Basic working knowledge of the JHHS revenue cycle
• Requires knowledge of insurance claim filing, billing principles and appeals processes.
• Requires knowledge of standard PC word processing, spreadsheet, and database applications.
• Requires knowledge of Maryland Medicare waiver, clinical guidelines, EMTALA, coordination of benefits
• HIPAA regulations, CMS regulations, the Affordable Care Act and Maryland Healthcare laws
• Requires the ability to read and understand a patient medical record as it relates to preauthorization
• Requires the ability to identify through investigation and analysis, underlying causes and contributing factors to areas of weakness and problems identified related to denial management & prevention
• Requires basic working knowledge of ICD10CM, CPT and HCPCS, coding and medical terminology.
• Knowledge of revenue cycle processes and how it impacts denials.

SKILLS

• Demonstrated ability to coordinate and lead efforts related to denials management & prevention.
• Ability to draft documentation of substantial complexity.
• Requires proven analytical ability and organizational skills necessary to organize/assess information and provide recommendations based on data analysis.
• Must possess excellent verbal and written communication skills to support interaction and participation in meetings with physicians, payer representatives, MHA, and representatives of other departments within our organization (Medical Records, Utilization Review, registration, etc.).
• Ability to resolve complex denials

QUALIFICATIONS

Education:

• Associate’s Degree in Accounting, Business Administration, Government, Health Administration, Finance, Nursing or related field preferred or,

WORK EXPERIENCE

• Minimum of 5+ years of experience working in Healthcare Revenue Cycle management related to charging, billing and denials.
• 3+ years of experience analyzing large/complex data sets and using reporting/analytical tools

Salary Range: Minimum 26.12/hour - Maximum 43.11/hour. Compensation will be commensurate with equity and experience for roles of similar scope and responsibility.

In cases where the range is displayed as a $0 amount, salary discussions will occur during candidate screening calls, before any subsequent compensation discussion is held between the candidate and any hiring authority.

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