Senior Denials Prevention Analyst

This is a fully remote position, open to applicants in California.

📋 Description

• Conduct analytics on revenue cycle denials to identify trends, ascertain root causes, and prioritize opportunities for preventing denials.

• Execute targeted account sampling and case reviews to verify findings and outline corrective measures.

• Create analytical summaries, denial-prevention presentations, reports, and updates for leadership.

• Facilitate and lead discussions across various functions, integrating topics from interdependent workgroups.

• Develop and sustain action plans that include owners, timelines, and success metrics; document minutes, takeaways, next steps, and follow-up actions.

• Track denial-prevention KPIs, progress on initiatives, revenue impact, fluctuations, and obstacles.

• Conduct root-cause analysis in collaboration with Patient Access, Patient Financial Clearance, UM/CM, CDI, HIM/Coding, Clinical Operations, and PFS.

• Assist in the creation and execution of denial-prevention strategies, workflows, and playbooks, monitoring their effectiveness through KPI reporting.

• Stay informed on payer policy changes, national guidelines, and updates from CMS/Medicare/Medicaid.

• Maintain dashboards, action plans, and performance reports regarding denials for leadership review.

• Prepare reports on denials and summarize findings; document analyses and outcomes while escalating systemic risks and barriers.

⛳️ Requirements

• High school diploma or GED equivalent. Required

• A minimum of five (5) years of progressively responsible and directly related work experience, preferably in denial prevention, denial management, prior authorization, or revenue cycle roles.

• At least two (2) years of experience in denial prevention, denial recovery, prior authorization, registration, coding, or denial management within a healthcare environment.

• 1-2 years of experience in statistical analysis.

• Experience in at least two of the following domains: PAS, PFC, HIMS, Revenue Integrity, Coding, Professional Billing and Follow-up, Hospital Billing and Follow-up, Denial Prevention, Denial Management/Recovery, or Payment Compliance.

• Proficient understanding of government and non-government payer requirements, reimbursement regulations, laws, and guidelines that affect billing and collection activities.

• Familiarity with Epic Hospital and/or Professional Billing; strong skills in Epic reporting, particularly Slicer/Dicer.

• Capability to analyze and formulate solutions for complex problems.

• Knowledge of medical terminology, CPT-4, ICD-9/ICD-10, HCPCS, and modifiers.

• Exceptional verbal and written communication skills.

• Proficient in Microsoft Office, especially with strong Excel skills including VLOOKUP, IF, IS, and macro commands.

• CPC - Certified Professional Coder or CRCR - Certified Revenue Cycle Representative certification is required.

• Bachelor’s degree in a relevant field from an accredited college or university is preferred.

• Preferred advanced reporting skills in tools such as Tableau, Power BI, SQL, etc.

🏝️ Benefits

• Comprehensive health insurance plans.

• Retirement savings options with employer matching.

• Opportunities for professional development and continuing education.

• Flexible work arrangements and paid time off.

• Supportive and collaborative work environment.