Denial Management Analyst

This position is responsible for actively supporting the execution of strategic initiatives, process re-design, root cause analysis, metric/report development and special projects as it relates to denials management. The Denial Management Analyst understands advanced concepts within Revenue Cycle including Coding, Registration or Billing Office processes. Strong data analysis and/or clinical documentation knowledge is a requirement of this position. The analyst serves as an internal consultant in the area of expertise. He or she consistently seeks to acquire and master new knowledge and skills to improve methods and systems and is recognized by others as an expert in the field of denial prevention. In addition, he or she is willing and able to acquire and master new knowledge and skills outside of their normal field.

Evaluates and ensures that all claims denied or underpaid inappropriately by payors are identified, appealed and reversed.
- Proactively works with multidisciplinary teams within operations departments, revenue cycle and finance to develop procedures to reduce the number of denials received through reporting of denials and education of denial trends.
- Works with management on payor contract interpretation, updating and distribution of correspondence to hospital staff as required.
- Compiles, analyzes and reports on data related to denials, revenue opportunities and revenue leakage.
- Categorizes denials based on root cause findings and distributes reports and metrics to applicable management and teams
- Serves as a resource when necessary for billing and reimbursement issues
- Continuously reviews applicable regulations, updates and maintains current knowledge
- Performs special audit requests for denials and assists in the writing of appeal letters.
- Other duties as assigned

-Analyze information to assist customers in the development of improvement plans.

-Defines, designs, implements, and coordinates focused studies to establish baselines, assess the impact of selected interventions, and examine topics with require more rigorous investigation.

- Consult with others to assure improvement plans are implemented, evaluated, and modified as appropriate.

-Act as an expert consultant on a variety of advanced performance improvement methodologies.

-Facilitate assigned teams through selection and application of appropriate improvement methods and tools; management of group process and team dynamics; provision of just-in-time training to team members; design and interpretation of baseline and feedback data; coordination of efforts across department and disciplines; and communication and reporting of progress and barriers.

-Design and facilitate educational offerings to address learning needs of senior leadership, department managers, and staff.

-Provide education and continually reinforce the goals of performance improvement along with creative approaches to achieving balance between intelligent resource use, customer service, and quality patient outcomes.

-Demonstrates ability to provide care or service adjusting approaches to reflect developmental level and cultural differences of population served.

What is the minimum level of education needed to perform this job, if any?

Bachelors Degree

List: Quality, Business/Finance, Data Analysis, or Healthcare related field

Preferred Education

What level of education is preferred for this job, but not required?

Advanced Degree:

List: Quality, Finance, Data Analysis, or Healthcare related field

Experience: Minimum Experience

What is the minimum level of experience needed to perform this job, if any?

2-3 years experience in healthcare revenue cycle.

Preferred Experience

What level of experience is preferred for this job, but not required?

4 years experience in Hospital/Clinic Revenue Cycle as Supervisor, Coder, Auditor, Analyst or other professional
level Revenue Cycle position.

Experience in managed care contracts, reconciling patient accounts, and balancing payment transactions against contract rates and terms is strongly desired
- Work experience in a Revenue Cycle department
- Ability to read and interpret medical charts and related documentation
- Experience in hospital operations and general understanding of revenue cycle with an emphasis on billing, coding, charge capture and reimbursement methodologies
- Keen attention to detail with ability to spot trends and proactively reduce denials
- Critical thinker with demonstrated ability to perform root cause analysis, problem solve, prepare and implement action plans and lead improvement initiatives
- Strong oral and written communication skills
- Excellent interpersonal skills and experience interacting with clinicians and operations leadership

- Knowledge of data analysis, forecasting, and financial analysis

-Process Improvement skills

-Customer Service Skills

-Knowledge of database development and maintenance

-Consultation Skills

- Team Facilitation and Process Skills

- Teaching Skills

- Performance Improvement Skills

- Knowledge of Regulatory Standards

- Knowledge of Peer Review and Credentialing Systems

-Knowledge of Teaching Learning Theory and Methods