Denials Managment Prevention Analyst Remote

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  

Job Location: Remote

The role you will contribute:

Responsible for denials prevention, root cause analysis, and identifying and implementing operational and financial process improvement opportunities to reduce denials and write-offs and maximize reimbursements. This position collects, analyzes, and reports data to drive meaning into operations and for special denials management projects. Additionally, this role develops, interprets, and presents financial, management, and statistical reports to assist in the strategic and operational management of denial management functions. In addition, this position leverages the interpretation of payor contracts and state and federal regulatory guidelines to maximize revenue realization. This role also develops and maintains job aides, training materials, playbooks, and other resources utilized by denial management staff, and trains or retrains denials management staff. Ensures compliance with all applicable local, state, and federal agencies and accrediting bodies.

The value you will bring to the team:

• Collects, analyzes, and reports data for insights into denials management operations and special prevention projects.

• Communicates and presents insights and recommendations to the denials management committee on prevention activities.

• Coordinates material and provides updates for key denials prevention program documentation.

• Reviews managed care contracts and compares them against patient claims to identify and prevent claim underpayments.

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

• Tracks payer audit requests and monitors adherence to contractual terms, communicating violations to the managed care contract team.

• Leads denials management prevention projects by gathering and analyzing data to support process improvement.

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

• Onboards and continuously trains denials management staff on workflow, technology, policies, and procedures.

• Travels to individual facilities or business offices as needed to conduct trainings, provide operational support, and attend meetings.

• Communicates and coordinates with various individuals and departments to assist with monitoring claims prevention activities.

• Strives to meet and exceed productivity and quality expectations, escalating concerns or difficulties in a timely manner for management action.

• Performs other duties as assigned.

The expertise and experiences you'll need to succeed:

• High School Grad or Equiv Required

• 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

• Ability to multitask and function in a fast-paced environment

• Ability to communicate effectively in written and oral form with diverse populations

• Have a good understanding of insurance reimbursement related to all payers including but not limited to Government, Medicaid, Medicaid HMO products (i.e. VA, Tricare, Crimes Comp, Prisoners, etc.) and Managed Care / Commercial products

• Uses discretion when discussing personnel/patient related issues that are confidential in nature

• SQL experience

• Ability to translate user requirements into functional & design specifications

• Comfort with interpreting clinical documentation and medical record to identify improvement opportunities to prevent future denials