Denials Prevention Analyst - Physician Based

American Addiction Centers • Milwaukee, WI

1d • $29 - $43 • Remote

About The Position

Applying problem-solving skills, the analyst will partner with the Senior Analyst to perform root cause analysis across large volumes of denials data in order to seek insight on areas of interest Evaluates and maintains the proper level of data integrity within the denial mitigations databases. Supporting claims denials reductions and increased revenues through process redesign, root cause analysis, and development of metrics and reports. Tracks and analyzes denial data to identify, recommend, and implement opportunities to secure legitimate revenue for the organization. Identifies trends or patterns that impact payment optimization, and collaborates with departments to establish action plans, initiatives, and policies to reverse negative denial patterns. Analyzes and reviews third party payer denial of medical claims and develops and executes strategies to decrease denials system wide to optimize revenue. Identifies revenue opportunities and provides appropriate investigation, follow up and resolution. Implements plans and partners with Managed Care Contracting to ensure proper adherence to contracts that does not affect revenue generation. Generates, and audits various revenue, financial, statistical and/or quality reports surrounding the denial prevention area of focus.

Requirements

• Bachelor's Degree or equivalent knowledge. Finance, Healthcare Finance, Accounting, Audit or related field.
• Typically requires 3 years of experience in medical billing, healthcare finance, accounting, internal audit and/or coding that includes experience in identifying problems and opportunities for improved workflows, developing processes and procedures to reduce denials, and consulting with leadership on complex denial issues.
• Ability to communicate with key executive stakeholders, system-wide, at both institutional and corporate levels.
• Skills and experience in successfully leading a functional team and training staff on processes and procedures.
• Demonstrated ability to work collaboratively with other departments and external organizations.
• Excellent written and verbal communication skills and the ability to communicate effectively with all levels of employees and management.
• Ability to effectively address difficult and controversial issues.
• Strong analytic, time management and organizational skills, with a high attention to detail.
• Demonstrated proficiency in the Microsoft Office Suite (Word, Excel, PowerPoint) or similar products and knowledge of electronic health.
• Serve as liaison to department administration, physicians, clinic administration, information services, business offices, financial offices, and other stakeholder departments
• This position requires travel, therefore, will be exposed to weather and road conditions.
• Operates all equipment necessary to perform the job.
• Exposed to a normal office environment.

Responsibilities

• Partner with the Senior Analyst to perform root cause analysis across large volumes of denials data.
• Evaluates and maintains the proper level of data integrity within the denial mitigations databases.
• Supporting claims denials reductions and increased revenues through process redesign, root cause analysis, and development of metrics and reports.
• Tracks and analyzes denial data to identify, recommend, and implement opportunities to secure legitimate revenue for the organization.
• Identifies trends or patterns that impact payment optimization, and collaborates with departments to establish action plans, initiatives, and policies to reverse negative denial patterns.
• Analyzes and reviews third party payer denial of medical claims and develops and executes strategies to decrease denials system wide to optimize revenue.
• Identifies revenue opportunities and provides appropriate investigation, follow up and resolution.
• Implements plans and partners with Managed Care Contracting to ensure proper adherence to contracts that does not affect revenue generation.
• Generates, and audits various revenue, financial, statistical and/or quality reports surrounding the denial prevention area of focus.

Benefits

• Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including:
• Compensation Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training Premium pay such as shift, on call, and more based on a teammate's job Incentive pay for select positions Opportunity for annual increases based on performance
• Benefits and more Paid Time Off programs Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability Flexible Spending Accounts for eligible health care and dependent care expenses Family benefits such as adoption assistance and paid parental leave Defined contribution retirement plans with employer match and other financial wellness programs Educational Assistance Program

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level