Denials Prevention Strategist

Baptist Health Care; Pensacola (FL); Vor Ort; USD 60.000 - 80.000; Vollzeit

Zusammenfassung

Baptist Health Care seeks a Denials Prevention Specialist to proactively identify, analyze, and mitigate denial trends across the revenue cycle, collaborating with Patient Access, Coding, Clinical Departments, and Revenue Cycle teams to ensure accurate claim submission.

The role focuses on root cause analysis, education, and process improvements to prevent denials before they occur, with a strong emphasis on dashboards and leadership reporting.

Qualifikationen

• Bachelor's Degree in Business, Health Care Administration or related field required.
• Three years revenue cycle experience in billing, coding or denial management.
• Three years denials research and resolution experience preferred.
• Three years experience with EHR and billing systems (Epic, Cerner, Meditech) preferred.

Aufgaben

• Monitors, tracks, and trends denial data to identify systemic issues and opportunities for prevention.
• Performs root cause analysis on denials (authorization, eligibility, coding, medical necessity, timely filing).
• Develops actionable insights and recommendations to reduce denial rates and rework.
• Ensures compliance with payer requirements, CMS guidelines, and internal policies.
• Creates and maintains denial dashboards, reports and presentations (KPIs such as denial rate, overturn rate, preventable denials).
• Presents findings and recommendations to leadership and committees for implementation.
• Tracks effectiveness of interventions and process changes.
• Serves as a liaison between departments to ensure alignment in denial prevention efforts.
• Works with managed care/payer relations on recurring denial issues for contract support.
• Participates in payer JOC meetings to address and resolve systemic denial drivers.

Kenntnisse

Denials prevention

Root cause analysis

Data analysis

Process improvement

Ausbildung

Bachelor's Degree in Business, Health Care Administration or related field

Tools

Epic

Cerner

Meditech

Jobbeschreibung

Baptist Health Care seeks a Denials Prevention Specialist to proactively identify, analyze, and mitigate denial trends across the revenue cycle, collaborating with Patient Access, Coding, Clinical Departments, and Revenue Cycle teams to ensure accurate claim submission.

The role focuses on root cause analysis, education, and process improvements to prevent denials before they occur, with a strong emphasis on dashboards and leadership reporting.