Denials Prevention Analyst

Advocate Aurora Health; Milwaukee (WI); Remote; Full time

Job summary

A leading healthcare organization is seeking a Revenue Cycle Analyst to optimize revenue through denial prevention. The role involves analyzing denial data, collaborating with departments, and implementing strategies to reduce claims denials. This position is remote, offering a dynamic work environment and opportunities for professional growth.

Benefits

Paid Time Off

Health and welfare benefits

Flexible Spending Accounts

Educational Assistance Program

Qualifications

• Typically requires 3 years of experience in medical billing or healthcare finance.
• Experience in identifying problems and developing processes to reduce denials.

Responsibilities

• Perform root cause analysis on denials data to identify trends.
• Support claims denials reductions through process redesign.
• Analyze third party payer denial of medical claims.

Skills

Communication

Analytic Skills

Time Management

Organizational Skills

Education

Bachelor's Degree in Finance, Healthcare Finance, Accounting, Audit or related field

Tools

Microsoft Office Suite

Job description

Department:

10349 Enterprise Revenue Cycle - Revenue Recovery Denials Prevention

Status:

Full time

Benefits Eligible:

Yes

Hou rs Per Week:

40

Schedule Details/Additional Information:

First Shift Hours 8:00am to 430Pm or 8:30am to 5:00pm

This is a REMOTE Opportunity

Major Responsibilities:

• 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.

Education/Experience Required:

• 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.

Knowledge, Skills & Abilities Required:

• 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

Physical Requirements and Working Conditions:

• 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.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.

#Remote

#LI-Remote

Pay Range

$28.05 - $42.10

Our CommitmenttoYou:

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, andShort- 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

About Advocate Health

Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation’s largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.