AdventHealth Denials Management Prevention Consultant in Altamonte Springs, Florida
Denials Management Prevention Analyst AdventHealth Corporate
Location Address: 900 Hope Way Altamonte Springs, Florida 32714
Top Reasons To Work At AdventHealth Corporate
Immediate Health Insurance Coverage
Career growth and advancement potential
- Full-Time, Monday – Friday
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.
What You Will Need:
Associate’s Degree or five + years of experience
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
Proficiency in data warehousing and business intelligence platforms
Proficiency in Microsoft Suite applications, specifically Excel and Word applications, as well as Outlook
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.
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.