Senior Denial Analyst
Share
Job Location:
Somerville, NJ - USA
Monthly Salary:
$ 78000 - 113453
Posted on:
Yesterday
Vacancies:
1 Vacancy
Job Summary
Site: The General Hospital Corporation
The role is responsible for ensuring the highest quality of work via daily management of EPIC WQs and reporting writing appeals monitoring analysis and collaboration with department subject matter experts. This position works within the hospital systems revenue cycle operations specializing in the resolution and prevention of prior authorization denials across high-dollar high-risk service lines. This role focuses on elective surgical cases complex outpatient procedures infusion therapies and emergent/urgent admissions. The position leverages clinical documentation payer policy expertise and cross-functional collaboration to drive financial recovery reduce denial rates reduce write-offs and improve authorization workflows. This position also assists in the development implementation and monitoring of new and existing qualitative and quantitative key performance indicators (KPI) for the Denials team and works with departments to develop the appropriate processes monitoring controls and reporting. The role will also develop and update policies and procedures in these areas for reference materials and new hire onboarding. The position compiles and summarizes information presenting results to Patient Access leadership Revenue Cycle Operations and other MGB Departments as needed.
Does this position require Patient Care
No
Essential Functions
-Performs advanced data mining from Slicer /Dicer (Revenue denials write-offs) and other data analytic tools to identify denial and write-off trends and works with Revenue Operations Practices and Prior Authorization teams to create daily weekly or monthly reports as needed.
-Performs root cause analysis and trend reporting to identify systemic issues and payer-specific denial patterns and analyzes denial and write-off trends; presents monthly reports to Practices and Revenue Operations with actionable insights and recommendations for prevention.
-Collaborates and serves as liaison with coding clinical registration Prior Authorization Revenue Operations and Practice teams to resolve and address systemic issues contributing to claim denials.
-Independently drafts nuanced appeals citing clinical documentation payer policy and coding guidelines; identifies and resolves retro authorization gaps across service lines.
-Monitors compliance with all organizational policies regulatory standards and documentation protocols; identifies QA opportunities for Prior Authorization and Practice teams and monitors KPIs such as appeal success rates denial overturn percentages retro authorizations and revenue recovery.
-Prepares and presents detailed reports on denial statistics and QA findings to management highlighting areas for improvement.
-Trains and mentors staff on best practices for preventing denials providing guidance and training to analysts on appeal strategy write-offs root cause analysis documentation standards and payer compliance while fostering team development.
-Assists in the development of enhancements to existing systems related to Denials /Write-offs Revenue Operations and Quality Assurance.
-Recommends process improvements based on data analysis and industry best practices to enhance overall operational effectiveness such as the development of reusable appeal templates the use of artificial intelligence retro-auth reporting and troubleshooting guides to streamline team operations and reduce rework.
EducationBachelors Degree Healthcare Administration required or Bachelors Degree Business required or Bachelors Degree Related Field of Study requiredCan this role accept experience in lieu of a degreeYesLicenses and CredentialsExperienceExperience in claims processing denial management or quality assurance within a healthcare setting 3-5 years required and Experience in denial management and/or healthcare compliance 2-3 years requiredKnowledge Skills and Abilities- Strong analytical skills to interpret data and identify trends. - Excellent problem-solving abilities and attention to detail. - Proficient in using healthcare management software and tools for data analysis. - Effective communication skills for collaborating with cross-functional teams. - Ability to train and educate staff on denial management processes. - Knowledge of healthcare regulations compliance standards and strong knowledge of payer policies.Physical RequirementsStanding Occasionally (3-33%) Walking Occasionally (3-33%) Sitting Constantly (67-100%) Lifting Occasionally (3-33%) 20lbs - 35lbs Carrying Occasionally (3-33%) 20lbs - 35lbs Pushing Rarely (Less than 2%) Pulling Rarely (Less than 2%) Climbing Rarely (Less than 2%) Balancing Occasionally (3-33%) Stooping Occasionally (3-33%) Kneeling Rarely (Less than 2%) Crouching Rarely (Less than 2%) Crawling Rarely (Less than 2%) Reaching Occasionally (3-33%) Gross Manipulation (Handling) Constantly (67-100%) Fine Manipulation (Fingering) Frequently (34-66%) Feeling Constantly (67-100%) Foot Use Rarely (Less than 2%) Vision - Far Constantly (67-100%) Vision - Near Constantly (67-100%) Talking Constantly (67-100%) Hearing Constantly (67-100%) Remote399 Revolution Drive40RegularDay (United States of America)1200 The General Hospital Corporation is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race color religious creed national origin sex age gender identity disability sexual orientation military service genetic information and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process to perform essential job functions and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973 the Vietnam Veterans Readjustment Act of 1974 and Title I of the Americans with Disabilities Act of 1990 applicants who require accommodation in the job application process may contact Human Resources at .
Mass General Brigham relies on a wide range of professionals including doctors nurses business people tech experts researchers and systems analysts to advance our mission. As a not-for-profit we support patient care research teaching and community service striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.
Job Summary
SummaryThe role is responsible for ensuring the highest quality of work via daily management of EPIC WQs and reporting writing appeals monitoring analysis and collaboration with department subject matter experts. This position works within the hospital systems revenue cycle operations specializing in the resolution and prevention of prior authorization denials across high-dollar high-risk service lines. This role focuses on elective surgical cases complex outpatient procedures infusion therapies and emergent/urgent admissions. The position leverages clinical documentation payer policy expertise and cross-functional collaboration to drive financial recovery reduce denial rates reduce write-offs and improve authorization workflows. This position also assists in the development implementation and monitoring of new and existing qualitative and quantitative key performance indicators (KPI) for the Denials team and works with departments to develop the appropriate processes monitoring controls and reporting. The role will also develop and update policies and procedures in these areas for reference materials and new hire onboarding. The position compiles and summarizes information presenting results to Patient Access leadership Revenue Cycle Operations and other MGB Departments as needed.
Does this position require Patient Care
No
Essential Functions
-Performs advanced data mining from Slicer /Dicer (Revenue denials write-offs) and other data analytic tools to identify denial and write-off trends and works with Revenue Operations Practices and Prior Authorization teams to create daily weekly or monthly reports as needed.
-Performs root cause analysis and trend reporting to identify systemic issues and payer-specific denial patterns and analyzes denial and write-off trends; presents monthly reports to Practices and Revenue Operations with actionable insights and recommendations for prevention.
-Collaborates and serves as liaison with coding clinical registration Prior Authorization Revenue Operations and Practice teams to resolve and address systemic issues contributing to claim denials.
-Independently drafts nuanced appeals citing clinical documentation payer policy and coding guidelines; identifies and resolves retro authorization gaps across service lines.
-Monitors compliance with all organizational policies regulatory standards and documentation protocols; identifies QA opportunities for Prior Authorization and Practice teams and monitors KPIs such as appeal success rates denial overturn percentages retro authorizations and revenue recovery.
-Prepares and presents detailed reports on denial statistics and QA findings to management highlighting areas for improvement.
-Trains and mentors staff on best practices for preventing denials providing guidance and training to analysts on appeal strategy write-offs root cause analysis documentation standards and payer compliance while fostering team development.
-Assists in the development of enhancements to existing systems related to Denials /Write-offs Revenue Operations and Quality Assurance.
-Recommends process improvements based on data analysis and industry best practices to enhance overall operational effectiveness such as the development of reusable appeal templates the use of artificial intelligence retro-auth reporting and troubleshooting guides to streamline team operations and reduce rework.
Qualifications
Additional Job Details (if applicable)
Remote Type
Work Location
Scheduled Weekly Hours
Employee Type
Work Shift
Pay Range
$78000.00 - $113453.60/AnnualGrade
7EEO Statement:
Mass General Brigham Competency Framework
At Mass General Brigham our competency framework defines what effective leadership looks like by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance make hiring decisions identify development needs mobilize employees across our system and establish a strong talent pipeline.
Required Experience:
Senior IC
Key Skills
- Splunk
- IDS
- Microsoft Access
- SQL
- Cybersecurity
- Intelligence Experience
- Malware Analysis
- Tableau
- Analysis Skills
- SAS
- Data Analysis Skills
- Analytics
About Company
Patients at Mass General have access to a vast network of physicians, nearly all of whom are Harvard Medical School faculty and many of whom are leaders within their fields.
