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Denials Operations Expert

3 months ago

Remote, Oregon, United States The Wilshire Group Full time

Wilshire hires only the brightest and most experienced professionals in the healthcare revenue cycle management industry. Wilshire will take the time to get know you and your employment history. We will then place you in a role that will lead to a path of career success.


Job Description: Denials Operations Expert

Location: Remote (PST hours)
Travel: 10-15%
Compensation: 65% Fee Sharing

About The Wilshire Group:

The Wilshire Group is a premier healthcare consulting firm that partners with hospitals, health systems, and academic medical centers across the United States to provide strategic, operational, and technological solutions. With a focus on revenue cycle management, The Wilshire Group helps clients optimize their financial performance while ensuring the highest level of patient care. Our team is composed of industry experts who are dedicated to transforming healthcare operations and fostering long-term success for our clients.

Position Overview:

We are seeking a Denials Operations Expert to join our dynamic team. This role is critical in helping our healthcare clients minimize revenue losses by effectively managing and resolving insurance denials. The ideal candidate will have a deep understanding of the healthcare revenue cycle, a proven track record in denials management, and the ability to implement process improvements that enhance efficiency and financial outcomes.

Key Responsibilities:

  • Denials Management: Analyze, track, and resolve denied claims across various payers to recover revenue.
  • Process Improvement: Identify root causes of denials and develop strategies to reduce future occurrences through process enhancements and staff training.
  • Client Consultation: Provide expert guidance to clients on best practices for denial prevention and resolution, including the use of technology and data analytics.
  • Collaboration: Work closely with client teams, including billing, coding, and compliance departments, to ensure seamless operations and timely resolution of denials.
  • Reporting: Prepare detailed reports on denial trends, financial impact, and recovery efforts to inform client decision-making and strategy.
  • Training: Educate client staff on denial management techniques, tools, and industry changes to build internal capacity for ongoing success.

Qualifications:

  • Experience: Minimum of 5 years in healthcare revenue cycle management, with a strong focus on denials management and recovery. Must have at least 5 years of Epic HB (Hospital Billing) experience.
  • Skills: Expertise in analyzing denials data, problem-solving, and process improvement. Strong communication and interpersonal skills for client-facing interactions.
  • Knowledge: Comprehensive understanding of payer policies, regulatory requirements, and the healthcare reimbursement landscape.
  • Technical Proficiency: Familiarity with revenue cycle management software, electronic health records (EHR), and data analytics tools.
  • Education: Bachelor's degree in Healthcare Administration, Business, or a related field preferred. Relevant certifications (e.g., CHRI, CRCR) are a plus.

Benefits:

  • Flexibility: Work remotely with PST hours to accommodate client needs.
  • Compensation: Benefit from a competitive 65% fee-sharing compensation model.
  • Professional Growth: Join a team of industry experts and gain exposure to a wide range of healthcare organizations and challenges.
  • Travel: Occasional travel (10-15%) to client sites for on-site consultations and trainings.

How to Apply:

If you are passionate about improving healthcare operations and have the expertise to drive impactful results, we encourage you to apply. Please submit your resume and a cover letter detailing your experience and why you are a great fit for this role.


Wilshire is honored that you have taken the time to review/apply to our open position. We will now take the time to review your experience and be in touch with you soon.