Denials Management Prevention Analyst Remote

AdventHealth Corporate

All the benefits and perks you need for you and your family:

• Benefits from Day One

• Career Development

• Whole Person Wellbeing Resources

• Mental Health Resources and Support

Our promise to you:

Joining AdventHealth is about being part of something bigger. It's about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.

Shift : Monday-Friday; Full-time

Job Location : Remote; If local to CFL area, may be needs to go onsite

The role you'll contribute:

Under general supervision of the Executive Director of Denials Management, the Prevention Analyst is primarily responsible for denials prevention, root cause analysis, and identifying and implementing operational and financial process improvement opportunities to reduce denials and write-offs and to maximize reimbursements. This position collects, analyzes, and reports data to drive meaning into the operations and for special denials management projects. The Prevention Analyst develops, interprets, and presents financial, management, and statistical reports designed to assist in the strategic and operational management of denial management functions as well as leverages the interpretation of payor contracts and state and federal regulatory guidelines to maximize revenue realization. This position is also in charge of developing and keeping job aides, training materials, playbooks, and other resources utilized by denial management staff up to date and training or retraining denials management staff. Adheres to AHS compliance plan and to all rules and regulations of all applicable local, state and federal agencies and accrediting bodies. Actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all.

The value that you bring to the team:

• Collects, analyzes and reports data for insights into the denials management operations business and for special prevention and denials management projects. This includes identifying denial trends by root cause, payor related issues, physician, etc.

• Communicates & presents insights and recommendations with denials management committee on prevention activities as per set cadence.

• Coordinates material for and provides updates pertaining to the key denials prevention program documentation (e.g. issues logs, monthly report outs).

• Performs thorough review of managed care contracts and compares such contracts against patient claims to identify and prevent claim underpayments.

• Provides feedback to managed care on identified underpayment issues for remediation with the payor.

• Supports with tracking payer audit requests and monitors adherence to contractual terms. Communicates contract term violations to managed care contract team.

• Spearheads denials management prevention projects by gathering and analyzing data needed to support process improvement through the identification of trends by payer, root cause, location, etc.

• Develops and maintains up to date denials management staff job aides, training materials, and playbooks.

• Responsible for onboarding and continuous training of denials management staff on workflow, technology, policies and procedures, and other tools as per AHS policies and procedures.

• Able to travel to individual facilities / business offices as needed across the organization to conduct trainings, provide operational support and guidance, attend meetings, etc.

• Communicates and coordinates with various individuals and departments and assists with monitoring of the day to day activities related to claims prevention activities.

• Strives towards meeting and exceeding productivity and quality expectations to align performance with assigned roles and responsibilities. Escalates concerns or difficulties in meeting performance expectations in a timely manner for management action.

• Performs other duties as

Qualifications
The expertise and experiences you'll need to succeed :

• High School and five years experience

• Strong keyboard and 10 key skills

• Proficiency in Microsoft Suite applications, specifically Excel and Word applications, as well as Outlook

• Strong quantitative, analytical and organization skills

• Strong problem solving skills

• Proficiency in data warehousing and business intelligence platforms

• Ability to understand insurance terms and payment methodologies

• Ability to navigate accounts to perform research and gather additional information to identify root causes

• Interpersonal skills to promote teamwork throughout the denials management team

Preferred Qualifications :

• Experience in Billing, A/R follow up and denials management functions

• Prior reporting and analytics background

• SQL or similar Programming Language

• BI or Reporting tool certifications

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