Denial Prevention Analyst

The Denial Prevention Analyst performs data analysis on clinical and technical denials for assigned client(s), utilizing multiple analytics tools (including parsed 835 data, Epic BDC records, Access databases/SQL) to identify patterns and trends relative to acute denials. They will apply high level problem-solving skills to perform root cause analysis on denied accounts and extrapolates those causes across large volumes identified as denial trends for assigned facilities. They will use process improvement expertise and persuasion skills to guide and influence subject matter experts through assessments of operations and preparation of policies, procedures, and tip sheets that assist in remedying the root cause(s). This position is client-facing and coordinates monthly denial prevention committee meetings, serves as a liaison for assigned clients on revenue cycle related-denials issues, establishes and maintains client relationships to facilitate best practice implementations, and utilizes sound judgment and experience to make recommendations for correcting underlying issues impacting denials.

• Using defined monthly denial reports, performs deep dive analysis of denied accounts identifying: 1) denial root causes for short- and long-term solution planning; 2) trends in high dollar and/or volume denials for greatest focus and impact; 3) long-term reduction in final write-offs and net patient service revenue. From analysis, documents findings into defined templates for initial presentation and targeting of existing processes/procedures/education needs for further assessment and review.
• Assists DP Supervisor in monthly Denial Prevention onsite week kick-off and close-out meetings with assigned client leadership, adding supplemental information relative to identified trends, progress from prior actions, and next steps. Establishes complimentary relationships with appropriate stakeholders/committee members, including Finance Leadership, Revenue Cycle, Managed Care, and hospital ancillary department heads
• Produces documentation and trends prevention-related findings into defined templates, creates reports or summaries as needed. Performs reviews using all patient accounting, host, Epic and related systems used across their client to verify and summarize trends concisely and actionably
• Submits to DP Supervisor process improvement recommendations to remedy process, system, and education issues.
• Creates materials and assists in training denial prevention staff, revenue cycle site directors, committee members, and revenue cycle staff as necessary on denials-related trends and issues impacting their client
• Performs other duties as assigned

Education Required

4 Year/ Bachelors Degree

Preferred Education

Graduate Degree (Masters)

Required Licensure/Certification

Certified Revenue Cycle Representative (CRCR); LEAN Six Sigma Green Belt (must be obtained within 6 months of hire – employer-funded)

Minimum Years And Type Of Experience

3-5 years of acute revenue cycle

Scheduled Weekly Hours

40

Work Shift

Days (United States of America)

We’ll Also Reward Your Hard Work With

• Great health, dental and vision plans
• Prescription drug coverage
• Flexible spending accounts
• Life insurance w/AD&D
• Paid time off
• Tuition reimbursement
• And a lot more

Ensemble Health Partners provides reasonable accommodations to qualified individuals with disabilities in accordance with the Americans with Disabilities Act and applicable state and local law. If you require accommodation in the application process, please contact our Human Resources Department at 877-692-7780 or [email protected]. This department will make sure you get connected to a Human Resources representative that can assist you.

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