Denials Management Prevention Analyst

1103 Team Member Services; United States; On-site; USD 55,000 - 103,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Insurance

Paid Time Off from Day One

403-B Retirement Plan

4 Weeks 100% Paid Parental Leave

Career Development

Whole Person Well-being Resources

Mental Health Resources and Support

Pet Benefits

Job summary

AdventHealth is seeking a Denials Management Analyst to collect, analyze, and report data for insights into denials management operations and prevention projects. You will present insights and recommendations to the denials management committee on prevention activities and coordinate material for program documentation.

The role requires strong quantitative, analytical, and organizational skills, experience with data warehousing/BI platforms, and knowledge of insurance payment methodologies.

Qualifications

• Bachelor’s or higher degree not specified; High School Grad required.

Responsibilities

• Collects, analyzes, and reports data for insights into denials management operations and special prevention projects.
• Communicates 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.
• 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.
• Onboards and trains denials management staff on workflow, technology, policies, and procedures.
• Travels to facilities or offices to conduct trainings and provide operational support.

Skills

Strong analytics

Excel

Word

Outlook

SQL

Data warehousing

BI platforms

Insurance terms

Research capability

Multitask

Written/oral communication

Payer knowledge

Education

High School Grad

Tools

SQL

Job description

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

Benefits and Perks

• Medical Insurance
• Dental Insurance
• Vision Insurance
• Life Insurance
• Disability Insurance
• Paid Time Off from Day One
• 403-B Retirement Plan
• 4 Weeks 100% Paid Parental Leave
• Career Development
• Whole Person Well-being Resources
• Mental Health Resources and Support
• Pet Benefits

Schedule: Full time, Shift: Day (United States of America)

Address: 2600 LUCIEN WAY, MAITLAND, FL 32751

Job Description

• 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.

Knowledge, Skills, and Abilities

• Strong keyboard and 10 key skills [Required]
• Proficiency in Microsoft Suite applications, specifically Excel and Word applications, as well as Outlook [Required]
• Strong quantitative, analytical and organization skills [Required]
• Strong problem solving skills [Required]
• Proficiency in data warehousing and business intelligence platforms [Required]
• Ability to understand insurance terms and payment methodologies [Required]
• Ability to navigate accounts to perform research and gather additional information to identify root causes [Required]
• Interpersonal skills to promote teamwork throughout the denials management team [Required]
• Ability to multitask and function in a fast-paced environment [Required]
• Ability to communicate effectively in written and oral form with diverse populations [Required]
• 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 [Required]
• Uses discretion when discussing personnel/patient related issues that are confidential in nature [Required]
• SQL experience [Preferred]
• Ability to translate user requirements into functional & design specifications [Preferred]
• Comfort with interpreting clinical documentation and medical record to identify improvement opportunities to prevent future denials [Preferred]

Education

• High School Grad or Equiv [Required]

Work Experience

• 5+ years related experience [Required]
• Experience in Billing, A/R follow up and denials management functions [Preferred]
• Prior reporting and analytics background [Preferred]

Physical Requirements

Physical Requirements - https://tinyurl.com/23km2677

Pay Range

Pay Range: $55,224.00 - $102,731.20

Background Screening Requirement (Florida Law) Certain positions are subject to Florida Level 2 background screening, including fingerprinting, as required by state law. Applicants may review general information about Florida’s background screening requirements at the Florida Care Provider Background Screening Clearinghouse: https://info.flclearinghouse.com/

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.

Every day, our fellow team members show up to work, unified by one shared mission: Extending the Healing Ministry of Jesus Christ. As a faith-based health care organization, our story is one of hope as we strive to heal and restore the body, mind and spirit. Though our facilities are spread across the country, this unwavering belief binds us together. Across every office, exam and patient room, we’re committed to providing individualized, holistic care. This is our Christian mission, and it inspires us to help make communities healthier and happier.