Denial Reduction & Analytics Manager

CCMC Cook Children's Medical Center; United States; On-site; USD 90,000 - 150,000; Full time

Job summary

Cook Children’s Medical Center seeks a Manager of Denial Reduction and Analytics to lead operational and technical direction across Revenue Integrity, Patient Access, PFS and CBO, guiding denial prevention strategies and analytics.

The role focuses on creating denial trends, reporting, training materials, and mentoring staff, with collaboration across finance and clinical departments to develop analytic tools for leadership.

Qualifications

• Bachelor's degree in related field preferred; five years hospital or physician revenue cycle or financial analysis experience required.
• Three years' leadership experience preferred; supervisory skills.
• Knowledge of Epic Systems Revenue Cycle Solutions preferred.

Responsibilities

• Provide guidance on activities related to denials: registration, financial clearance/authorization, coding, charging and billing.
• Develop denial trending, reporting and root cause analysis to support strategic decisions.
• Create documentation to support training and troubleshooting of system problems.
• Oversee use of tools to reduce and prevent denials; serve as a technical leader in denial reduction efforts.
• Collaborate with finance and clinical departments to develop ongoing analytic tools and ad-hoc reports for Revenue Cycle and Finance teams.

Skills

Leadership

Analytical thinking

Communication

Education

Bachelor's degree in Health Care Administration, Business, Accounting, Finance or related field

Tools

Epic Systems Revenue Cycle Solutions

Job description

Location: Calmont Operations Building Department: CBO/Patient Financial Services Shift: First Shift (United States of America) Standard Weekly Hours: 40 Summary: The Manager of Denial Reduction and Analytics provides operational and technical direction to the Revenue Integrity, Patient Access, Patient Financial Services (PFS) and Central Business Office (CBO).

Responsibilities

• Providing guidance and input on activities related to Denials: registration, financial clearance/authorization, coding, charging and billing.
• Develops denial trending, reporting and root cause to support strategic analyses and decision making。
• Create documentation to support training and assist in troubleshooting system problems。
• Oversee the use of appropriate tools to reduce and prevent denials。
• Serve as a technical leader and has overall responsibility for providing in-depth expertise with denial reduction efforts and processes that prevent denials。
• Working in conjunction with finance and clinical departments, the Manager of Denial Reduction and Analytics;
• Seeks to continually improve processes and avoid denials through optimal utilization of standardized workflows and participates in mentoring staff to support those functions。
• Develop best practices for reporting and other analytics to identify opportunities or problems, process improvements, and other system changes;
• Assist as needed in ongoing review of payer denial patterns。
• Work closely with clinical operations, Payor Relations, and revenue cycle departments to provide expertise to leadership in developing on-going analytic tools including ad-hoc queries and reports for members of the Revenue Cycle and Finance teams。

Qualifications

• Bachelor's degree in Health Care Administration, Business, Accounting, Finance or related field preferred。
• Five years hospital or physician revenue cycle or financial analysis experience required。
• Three years' experience in leadership role preferred。
• Ability to apply appropriate supervisory, management, and leadership techniques in an operational setting。
• Excellent ability to understand and interpret statistical reports and perform quantitative analysis。
• Knowledge of the principles of Information Systems in order to effectively analyze and make decisions。
• Excellent written and oral communication skills to effectively communicate with top leadership。
• Knowledge of healthcare related financial and/or accounting practices。
• Skill in problem-solving in a variety of settings and translation of data into actionable steps。
• Ability to deal effectively with constant changes and be a change agent。
• Detailed knowledge of health plan operations, reimbursement methodologies, payer contracts and clinical policies。
• Knowledge of state, federal and compliance regulations as they pertain to coding and billing processes and procedures。
• Prior experience with Epic Systems Revenue Cycle Solutions preferred。

About Us

Cook Children’s is an equal opportunity employer. As such, Cook Children’s offers equal employment opportunities without regard to race, color, religion, sex, age, national origin, physical or mental disability, pregnancy, protected veteran status, genetic information, or any other protected class in accordance with applicable federal laws. These opportunities include terms, conditions and privileges of employment, including but not limited to hiring, job placement, training, compensation, discipline, advancement and termination. Cook Children’s is a Texas-only employer. If you are hired, you will need to maintain your primary residence within the state of Texas, along with all licenses and credentials required for your position throughout your employment.

Promise, a strong word with deep meaning that everyone understands—especially kids. This is the foundation of our organization and what drives us to blaze new trails in medical care, research, advanced technology, as well as programs and initiatives that benefit children who may not otherwise have access to quality health care. Every day our employees come to work with the intention of keeping our Promise. It's the guiding principle that helps our patients and their families get better and stay healthy. As a member of our Cook Children's team, you can be an important part of making that happen.