Senior Denials Prevention Analyst

🔥 1 minute ago

🏄 California – Remote

🏄 California – Remote

💵 $57 - $76 / hour

⏰ Full Time

🟠 Senior

🧐 Analyst

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Stanford Health Care

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1885

🏥 Healthcare

⚕️ Healthcare Insurance

📚 Education

Healthcare • Healthcare Insurance • Education

Stanford Health Care is a major academic medical center affiliated with Stanford Medicine. It provides world-renowned patient care, emphasizes innovation and research, and offers a wide range of clinical services and career opportunities across nursing, advanced practice, allied health, laboratory, technology, administration, and other areas. The organization promotes values such as C-I-CARE (respect, courtesy, personal connection), sustainability, dedication, and community collaboration across physicians, researchers, professors, and students to advance health, healing, and knowledge globally.

📋 Description

• Perform revenue cycle denial analytics to trend issues, identify root causes, and prioritize denial prevention opportunities. • Conduct targeted account sampling and case reviews to validate findings and define corrective actions. • Prepare analytics summaries, denial-prevention PowerPoints and reports, and leadership readouts. • Lead and facilitate cross-functional discussions and connect interdependent workgroup topics. • Build and maintain action plans with owners, timelines, and success metrics; document minutes, takeaways, next steps, and follow-up communications. • Monitor denial-prevention KPIs, initiative progress, revenue impact, fluctuations, and barriers. • Lead root-cause analysis with Patient Access, Patient Financial Clearance, UM/CM, CDI, HIM/Coding, Clinical Operations, and PFS. • Help develop and implement denial-prevention strategies, workflows, and playbooks; monitor effectiveness through KPI reporting. • Monitor payer policy changes, national guidelines, and CMS/Medicare/Medicaid updates. • Maintain denial dashboards, action plans, and performance reports for leadership review. • Prepare denial reports and summary findings; document analyses and outcomes and escalate systemic risks and barriers.

🎯 Requirements

• High school diploma (or GED equivalent). Required • Five (5) years of progressively responsible and directly related work experience, with a preference for denial prevention, denial management, prior authorization, or revenue cycle specific experience. • Two (2) years’ experience in denial prevention, denial recovery, prior auth, registration, coding, or denial management related role within a healthcare setting. • 1-2 years of statistical analysis experience. • Domain experience across 2+ of the following areas: PAS, PFC, HIMS, Revenue Integrity, Coding, Professional Billing and Follow-up, Hospital Billing and Follow-up, Denial Prevention, Denial Management/Recovery, or Payment Compliance. • Working knowledge of government and non-government payer requirements, reimbursement rules, laws, and regulations that govern billing/collection activities. • Working knowledge of Epic Hospital and/or Professional Billing; strong proficiency in Epic reporting, especially Slicer/Dicer. • Ability to analyze and develop solutions to complex problems. • Working knowledge of medical terminology, CPT-4, ICD-9/ICD-10, HCPCS, and modifiers. • Excellent verbal and written communication skills. • Knowledge of Microsoft Office, including strong Excel knowledge and VLOOKUP, IF, IS, and macro commands. • CPC - Certified Professional Coder required OR CRCR - Certified Revenue Cycle Representative required. • Bachelor’s degree in a work-related field/discipline from an accredited college or university. Preferred. • Advanced reporting capabilities such as Tableau, Power BI, SQL, etc. preferred.