Denials Analyst
Denials Analyst
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Job Description
Job Family:
PFS General
Travel Required:
Clearance Required:
What You Will Do:
In collaboration with Revenue Cycle leadership the Revenue Cycle Denials Analyst will bring a deep understanding of payer denial trends claims processing strategies payer policy updates and accounts receivable resolution tactics. The Denials Analyst supports claims denials reductions and increased revenues through process redesign root cause analysis and development of metrics and reports. The role must also focus on denial prevention by collaborating with clinical teams operational partners the contracting team and insurance payers. The position facilitates regular reviews in partnership with denials-owning areas service lines and the RCO team IS partners and Rev Cycle leaders to support the identification of denials issues and develop countermeasures to resolution. This position requires forward-thinking individuals who seek opportunities to streamline workflows and apply technology to improve business processes with strategic goals in mind.
Denial prevention - Identify denial trends; provide documentation data/reporting to Revenue Cycle Management and owning area key stakeholders offer suggestions for process improvement and develop countermeasures in conjunction with operational areas.
Regularly tracks and analyzes denial data to identify recommend and implement opportunities to secure revenue for the organization; Analyzes and reviews third-party payer denial of medical claims and develops and executes strategies to decrease denials system-wide
Identifies trends or patterns that impact payment optimization and collaborates with departments to establish action plans initiatives and policies to reverse negative denial patterns
Researches and analyzes applicable regulatory coding and billing rules and educates departments on regulations processes and medical necessity requirements
Identifies revenue opportunities and provides appropriate investigation follow-up and resolution; Analyzes trends and inefficiencies in medical center charges and recommends suitable operational improvements in an effort to prevent incorrect payments and denials.
Complete monthly standard denials reports; Parse and share denial trends and data to operational areas for review on a monthly basis; attend needed follow-up calls for support in operational reviews amongst owning areas.
Identify and communicate system issues related to denials stemming from billing edits rejections and follow-up work queues with RCO and Billing management
Independently conduct insightful analysis to investigate trends in denial write-off data to aid in the identification and prioritization of denial prevention initiatives.
Independently facilitates discovery and design sessions for new complex build activities including new automation use cases or enhancements to existing functionality using best practices for automation design and development
Assists in the creation of automation design documents to support business decision-making process streamlining automation development and performance improvement to meet business and customer needs
Support in the submission of complex case reviews and appealing surrounding high-priority denials such as auth medical necessity COB etc.
Coordinate with Reporting/AQ Analyst to develop generate and audit various revenue financial statistical and/or quality reports surrounding the denial prevention area of focus
Support the development implementation and evaluation of existing policies and procedures related to denial management
Submit optimization tickets with the RCO team and/or Analytics to resolve issues support in testing and training as necessary
Support Rev Cycle management in the preparation of denials data and strategic opportunities for an executive-level audience
While Working with the Application Analysts will thoroughly test and document system upgrades and software modifications related to Denial Management
Provide training to AR specialists and other denials accountable owners assisting with denial management
Serves as an active team member; participates in department and company-wide initiatives; contributes to the overall culture
Development monitoring and follow-up of denial metrics within the revenue cycle
Develop maintain and distribute ad-hoc reports as needed
Provide support in process improvement initiatives
Maintain a denials issues log of acknowledged opportunities and track and monitor progress Perform other related duties as required
Maintains tracking documents and dashboards
Conduct special projects as needed
Perform other related duties as required
What You Will Need:
High School Diploma / GED or 3 years of relevant equivalent experience in lieu of diploma / GED.
5 years working within the following sectors: healthcare insurance business finance or customer service.
Working knowledge can be of the following: insurance claims billing coding follow-up finance accounting or customer service related responsibilities.
What Would Be Nice to Have:
Knowledge of claims denial management and healthcare collections activities
Epic Hospital/professionals modules preferred in an AR/Follow-up capacity
Knowledge of payor CARC and RARC codes and denial classes
What We Offer:
Guidehouse offers a comprehensive total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.
Benefits include:
Medical Rx Dental & Vision Insurance
Personal and Family Sick Time & Company Paid Holidays
Position may be eligible for a discretionary variable incentive bonus
Parental Leave
401(k) Retirement Plan
Basic Life & Supplemental Life
Health Savings Account Dental/Vision & Dependent Care Flexible Spending Accounts
Short-Term & Long-Term Disability
Tuition Reimbursement Personal Development & Learning Opportunities
Skills Development & Certifications
Employee Referral Program
Corporate Sponsored Events & Community Outreach
Emergency Back-Up Childcare Program
About Guidehouse
Guidehouse is an Equal Opportunity EmployerProtected Veterans Individuals with Disabilities or any other basis protected by law ordinance or regulation.
Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.
If you have visited our website for information about employment opportunities or to apply for a position and you require an accommodation please contact Guidehouse Recruiting at 1- or via email at . All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.
All communication regarding recruitment for a Guidehouse position will be sent from Guidehouse email domains including @ or . Correspondence received by an applicant from any other domain should be considered unauthorized and will not be honored by Guidehouse. Note that Guidehouse will never charge a fee or require a money transfer at any stage of the recruitment process and does not collect fees from educational institutions for participation in a recruitment event. Never provide your banking information to a third party purporting to need that information to proceed in the hiring process.
If any person or organization demands money related to a job opportunity with Guidehouse please report the matter to Guidehouses Ethics Hotline. If you want to check the validity of correspondence you have received please contact . Guidehouse is not responsible for losses incurred (monetary or otherwise) from an applicants dealings with unauthorized third parties.
Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.
Required Experience:
IC
Employment Type
Part-Time
