Senior Denials Prevention Analyst

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

📋 Description

• Analyze revenue cycle denials to identify trends, root causes, and prioritize opportunities for denial prevention.

• Conduct focused account sampling and case evaluations to validate findings and establish corrective actions.

• Create analytical summaries, denial prevention presentations, reports, and leadership briefings.

• Facilitate cross-functional discussions and link interdependent topics across various workgroups.

• Develop and sustain action plans with designated owners, timelines, and success metrics; document meeting minutes, key takeaways, next steps, and follow-up communications.

• Track denial prevention KPIs, the progress of initiatives, and their revenue impact; interpret fluctuations and escalate any barriers encountered.

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

• Assist in the creation and implementation of denial prevention strategies, workflows, and playbooks; assess effectiveness through KPI reporting.

• Keep abreast of payer policy changes, national guidelines, and updates from CMS/Medicare/Medicaid.

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

• Compile denial reports and summary findings; document analyses and outcomes, escalating any systemic risks and barriers.

⛳️ Requirements

• High school diploma (or GED equivalent). Required

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

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

• 1-2 years of experience in statistical analysis.

• Experience in at least 2 of the following areas: PAS, PFC, HIMS, Revenue Integrity, Coding, Professional Billing and Follow-up, Hospital Billing and Follow-up, Denial Prevention, Denial Management/Recovery, or Payment Compliance.

• Familiarity with government and non-government payer requirements, reimbursement rules, laws, and regulations that govern billing and collection activities.

• Proficient knowledge of Epic Hospital and/or Professional Billing; strong skills in Epic reporting, particularly Slicer/Dicer, with the ability to convert data into actionable insights.

• Capability to analyze and propose solutions to complex problems, including independently identifying issues through data analysis.

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

• Proficiency in Microsoft Office, particularly strong Excel skills including VLOOKUP, IF, IS, and macro commands for automation.

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

• Bachelor’s degree in a relevant field from an accredited institution. Preferred.

• Advanced reporting skills in tools such as Tableau, Power BI, SQL, etc. are preferred.

• Exceptional verbal and written communication skills; capable of presenting complex data in a clear manner to stakeholders.

• Ability to manage, organize, prioritize, multitask, and adapt to shifting priorities.

• Strong analytical and problem-solving abilities, good judgment, keen attention to detail, and thorough follow-through.

• Ability to establish and maintain effective working relationships.

🏝️ Benefits

• Competitive salary and comprehensive benefits package.

• Opportunities for professional development and career advancement.

• Collaborative work environment with a focus on teamwork and innovation.