Healthcare Utilization & Denials Data Analyst

MedStar Health; Baltimore (MD); On-site; USD 33,000 - 58,000; Full time

Job summary

MedStar Health is seeking a Utilization Management Specialist to join our team in Baltimore. The role supports concurrent and retrospective utilization management by collaborating with payors, MedStar Financial Services, and Case Management staff to assure certification and payment of acute care days.

The ideal candidate has knowledge of databases and business software applications, strong analytical and problem-solving skills, and experience in case management or utilization review.

Qualifications

• High School Diploma or GED required.
• Knowledge of third-party reimbursement and medical terminology.
• 2 years related experience; 1 year in case management or utilization review.
• Associate degree in business or healthcare field preferred.

Responsibilities

• Analyzes and interprets data for the Denials Management Team and service lines; presents data to support decision-making.
• Collaborates with Finance, PFS, Operations, and service lines to gather denial/appeal and performance data; supports reports.
• Develops and maintains databases to assist Clinical Review Nurses with data capture and reporting; maintains confidentiality.
• Maintains care management and performance improvement databases; generates routine and ad hoc reports on utilization data.
• Tracks denial information for departments and supports performance improvement teams to improve processes.

Skills

Critical thinking

Problem-solving

Databases knowledge

Education

High School Diploma or GED

Associate degree in business or healthcare

Job description

MedStar Health is seeking a Utilization Management Specialist to join our team in Baltimore. The role supports concurrent and retrospective utilization management by collaborating with payors, MedStar Financial Services, and Case Management staff to assure certification and payment of acute care days.

The ideal candidate has knowledge of databases and business software applications, strong analytical and problem-solving skills, and experience in case management or utilization review.