Senior Denials Prevention Analyst

🕒 September 29

🇺🇸 United States – Remote

💵 $57 - $76 / hour

⏰ Full Time

🟠 Senior

🧐 Analyst

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Stanford Health Care

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1991

🏥 Healthcare

⚕️ Healthcare Insurance

💊 Pharmaceuticals

Healthcare • Healthcare Insurance • Pharmaceuticals

Stanford Health Care is a leading healthcare provider affiliated with Stanford University, offering a wide range of medical services, including primary, specialty, and emergency care. Known for its cutting-edge research and innovation in medicine, the facility also partners with Stanford Medicine and Stanford School of Medicine to provide top-tier medical education and research opportunities. Patient care is enhanced through their MyHealth online and mobile platforms, allowing easy access to medical records, appointment scheduling, and bill payments. Stanford Health Care is dedicated to improving health outcomes through advanced technology, personalized care, and comprehensive health services.

📋 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 help define corrective actions. • Prepare analytics summaries, denial prevention PowerPoints and reports, and leadership readouts. • Lead and facilitate cross-functional discussions and connect interdependent topics across workgroups. • 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, and revenue impact; explain fluctuations and escalate 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, and ability to translate data into actionable insights. • Ability to analyze and develop solutions to complex problems, including independently identifying problems through data analysis. • Working knowledge of medical terminology, CPT-4, ICD-9/ICD-10, HCPCS, and modifiers. • Knowledge of Microsoft Office, including strong Excel knowledge with VLOOKUP, IF, IS, and macro commands for automation. • 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. • Excellent verbal and written communication skills; ability to present complex data clearly to stakeholders. • Ability to manage, organize, prioritize, multi-task, and adapt to changing priorities. • Analytical and problem-solving skills, good judgment, attention to detail, and thorough follow-through. • Ability to establish and maintain effective working relationships.

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