Adventist Health System Denials Management Prevention Consultant in Altamonte Springs, Florida
Full Time, Monday-Friday
Adventist Health System Corporate Office
Be part of the Adventist Health System family.
Where you work matters. Working here is like being part of a family. Not just with those you serve, but also with your team members. It’s about making a difference, saving lives, and helping others live a fuller one. You’ll be joining a family of tens of thousands of team members who understand that what they do is bigger than healthcare. It is living out our mission to Extend the Healing Ministry of Christ and being there for someone every step of the way-body, mind, and spirit.
This is more than a career. It is a calling.
With hospitals and facilities in 9 states, you’ll have endless opportunities to take your talents, develop your skills, and grow as a professional in a place that truly cares about your success. If you are driven, compassionate, someone who always wants to go above and beyond because you care and believe what you do makes a difference – Adventist Health System is for you.
Under general supervision of the Executive Director of Denials Management, 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 AHS 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.
What you will be responsible for:
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 denials 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.
Provides feedback to managed care on identified underpayment issues for remediation with the payor.
Supports with tracking payer audit requests and monitors adherence to contractual terms. Communicates contract term violations to managed care contract team.
Spearheads denials management prevention projects by gathering and analyzing data needed to support process improvement through the identification of trends by payer, root cause, location, etc.
Develops and maintains up to date denials management staff job aides, training materials, and playbooks.
Responsible for onboarding and continuous training of denials management staff on workflow, technology, policies and procedures, and other tools as per AHS policies and procedures.
Able to travel to individual facilities / business offices as needed across the organization to conduct trainings, provide operational support and guidance, attend meetings, etc.
Communicates and coordinates with various individuals and departments and assists with monitoring of the day to day activities related to claims prevention activities.
Strives towards meeting and exceeding productivity and quality expectations to align performance with assigned roles and responsibilities. Escalates concerns or difficulties in meeting performance expectations in a timely manner for management action.
Performs other duties as assigned by management.
What you will need:
Associate Degree or 5+ years’ experience in healthcare
Strong keyboard and 10 key skills
Proficiency in data warehousing and business intelligence platforms
Ability to understand insurance terms and payment methodologies
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
This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.
We are an equal opportunity employer and do not tolerate discrimination based on race, color, creed, religion, national origin, sex, marital status, age or disability/handicap with respect to recruitment, selection, placement, promotion, wages, benefits and other terms and conditions of employment.