Denials Prevention Analytics Specialist

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

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.