Remote Montana,
Fort Lauderdale, Florida
Posted: 13-Mar-25
Location: Greenwood Village, Colorado
Categories:
Internal Number: 25010010
All the benefits and perks you need for you and your family:
- Benefits from Day One
- Paid Days Off from Day One
- Student Loan Repayment Program
- Career Development
- Whole Person Wellbeing Resources
Our promise to you:
Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind, and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.
Schedule: Full-time
Shift: Days
Location: 6061 S WILLOW DR, Greenwood Village, 80111
The role you’ll contribute:
The Prevention Analyst is primarily responsible for denials prevention, root cause analysis, and identifying and implementing operational and financial process improvement opportunities to reduce denials and write-offs and to maximize reimbursements. This position collects, analyzes, and reports data to drive meaning into the operations and for special denials management projects. The Prevention Analyst develops, interprets, and presents financial, management, and statistical reports designed to assist in the strategic and operational management of denial management functions as well as leverages the interpretation of payor contracts and state and federal regulatory guidelines to maximize revenue realization. This position is also in charge of developing and keeping job aides, training materials, playbooks, and other resources utilized by denial management staff up to date and training or retraining denials management staff. Adheres to AH compliance plan and to all rules and regulations of all applicable local, state and federal agencies and accrediting bodies. Actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all.
The value you’ll bring to the team:
- Collects, analyzes and reports data for insights into the denials management operations business and for special prevention and denials management projects. This includes identifying denial trends by root cause, payor related issues, physician, etc.
- Communicates & presents insights and recommendations with denials management committee on prevention activities as per set cadence.
- Coordinates material for and provides updates pertaining to the key denial’s prevention program documentation (e.g. issues logs, monthly report outs).
- Performs thorough review of managed care contracts and compares such contracts against patient claims to identify and prevent claim underpayments.
The expertise and experiences you’ll need to succeed:
Required qualifications:
- High School Diploma or GED
- Strong keyboard and 10 key skills
- Proficiency in Microsoft Suite applications, specifically Excel and Word applications, as well as Outlook
- Strong quantitative, analytical and organization skills
- Strong problem-solving skills
- Proficiency in data warehousing and business intelligence platforms
- Ability to understand insurance terms and payment methodologies
- Ability to navigate accounts to perform research and gather additional information to identify root causes
- Interpersonal skills to promote teamwork throughout the denials management team
- Ability to multitask and function in a fast-paced environment
- Ability to communicate effectively in written and oral form with diverse populations
- Have a good understanding of insurance reimbursement related to all payers including but not limited to Government, Medicaid, Medicaid HMO products (i.e. VA, Tricare, Crimes Comp, Prisoners, etc.) and Managed Care / Commercial products
- Uses discretion when discussing personnel/patient related issues that are confidential in nature
Preferred qualifications:
- Experience in Billing, A/R follow up and denials management functions
- Experience Prior reporting and analytics background
- SQL or similar Programming Language
- BI or Reporting tool certifications
- Ability to translate user requirements into functional & design specifications
- Comfort with interpreting clinical documentation and medical record to identify improvement opportunities to prevent future denials
