Senior Denials Analyst

Position: Senior Denials Analyst

Department: PFS Administration

Schedule: Full Time

POSITION SUMMARY:

Under the general direction of the Senior Director of Professional Billing & Hospital Billing, the Senior Denials Analyst (SDA) is responsible for assisting with hospital and Professional insurance denials in coordination with revenue cycle, compliance, clinical team members, finance, and others as appropriate. Assists in the review and analysis of system issues and resolves issues with various vendors to improve effectiveness. The SDA aides with development of departmental policy and coordinates team resources and activities to ensure HB Revenue cycle meets department goals and KPI's. The Senior Denial Analyst scrutinizes and creates reports to identify trend and process gaps; identifies and resolves problems for maximum revenue and reimbursement to Boston Medical Center. Assist with implementation and testing of new EPIC WQ's, system enhancements to optimize processes. Within the appropriate scope of responsibility and span of control, this position also works with various departments, BMC vendor partners and payers to develop the appropriate processes, monitoring controls and reporting to optimize operations. The SDA grounds all department activities to help BMC meet its core purpose: Exceptional Care, without exception. Furthermore, the MPFS supports and exhibits BMC's three core values: built on respect and empowered by empathy; moves mountains; and many faces create our greatness.

JOB REQUIREMENTS

EDUCATION:

Bachelor's degree in Business/Healthcare related field preferred or equivalent combination of formal education and work experience.

CERTIFICATES, LICENSES, REGISTRATIONS REQUIRED:

None

EXPERIENCE:

Minimum of five years of experience related to healthcare finance, and Revenue Cycle management required, preferably in an Academic Medical Center setting.

Requires an extensive knowledge of policies, procedures, systems and equipment relating to revenue cycle operations; of regulations and guidelines pertaining to third-party payers and self-pay patient

Requires the ability to develop policies, procedures, processes and programs; to analyze data and interpret statistics; to create a variety of narrative, statistical, and reports, including trend analysis; to identify and resolve problems; and to interpret guidelines and regulations

KNOWLEDGE AND SKILLS:

• Work requires interpersonal skills necessary in team building endeavors;
• to collaborate with other departments in support of the hospital goals and objectives; to establish and maintain effective, cooperative working relationships with all BMC employees to act as a liaison to third-party representatives and represent the hospital's interests while negotiating and obtaining contracts; and to train employees.
• Ability to work independently and possess effective time management skills to permit handling of multiple projects and or tasks
• Proven advanced level abilities in problem management, process analysis, and root cause analysis
• Interviewing/listening skills required to enable talking with individuals and groups about current processes and issues to ask the right questions to yield essential information that will be used to evaluate processes and determine potential solutions.
• Ability to communicate analysis including trends and opportunities to stakeholders both verbally and through writing
• At minimum, intermediate level of proficiency with Window based software, including but not limited to Microsoft Word, Outlook, Excel and PowerPoint
• Excellent presentation skills and interacting with senior levels of hospital management and with physician leaders.
• Excellent organizational and project management skills.
• Highly responsive to manage time effectively, attention to detail, and follow through.
• Strategic thinker with business acumen.
• Superior analytical skills to evaluate information gathered from multiple sources and synthesize into actionable information
• Excellent writing, interpersonal and organizational skills
• Working knowledge of healthcare applications including, but not limited to Epic and nThrive.

ESSENTIAL RESPONSIBILITIES / DUTIES:

General management responsibilities:

Aides with coordination of the HB and PB vendor liaison teams activities to achieve departmental goals for increasing cash collection by lowering insurance denials and patient account receivables. Interacts with BMC departments and outside vendors and payer representatives to address account resolution barriers.

Documents processes among important internal customers (including but not limited to, Case Management, Patient Access, Registration, Coding, outside vendors), identifies gaps, and recommends changes in policies, processes and procedures to address operational needs and to ensure continuous quality improvement.

Consistently monitors federal, state, and third-party payer regulations and guidelines and conveys updates to all department customers.

Cultivates, maintains, and enhances relationships with third party payers

Demonstrates problem-solving solutions and initiates changes as required. Develops, monitors, and uses reporting tools, monthly reports, and root cause analyses for denial review and management.

Communicate all denial trends and denial increases to Senior Director and Director in order to positively affect the volume of denials.

Work with ancillary departments' staff and third party payer provider representatives to identify source of denials and develop processes to eliminate and / or minimize denials and rejections and improve cash flow.

Maintains clear channels of communication for effective problem-solving, as related to denials and write-offs.

Depending on departmental needs the work may shift and the position will need to be able to prioritize and work on multiple assignments.

Assists in the training of employees within the Revenue Integrity denials department.

The Senior Denials Analyst performs all these functions in a manner that complies with standards established by Hospital Administration, Medical Staff, and outside regulatory and accreditation agencies.

Participates in continued learning and possess a willingness and ability to learn and utilize new technology and procedures that continue to develop in their role and throughout the organization

Preform other duties as required

Systems, analysis and reporting

Analyzes data and produces reports to identify areas of focus, account resolution, and the overall effectiveness and efficiency of the unit. Collects accurate and timely information and creates reports that highlight activity trends. Analyzes trends and interprets results. Identifies, reports, and resolves issues relating to all revenue cycle IT platforms (including but not limited to Epic, FINThrive, Medicare FISS, Trizetto, and HealthRise). Reviews operations and uses data to determine overall performance, team performance, error rates, system disconnects, etc. Prepares ad hoc and standard reports to communicate interpretational analysis. Recommends solutions to problems using existing resources in compliance with budgetary constraints.

Acts as resource person on changes in billing regulations and systems procedures and provides technical expertise for all applicable BMC Revenue Cycle and payer systems.

Professional use of self and personal development

Consistently demonstrates tact, courtesy and a positive attitude in communication and interaction with all internal and external customers. Collaborates to resolve issues and concerns relative to service quality, systems, and other identified problems. Represents the department at meetings and on committees. Participates in the decision and policy-making process on hospital-wide issues, particularly those which relate to Revenue Cycle activities, as assigned. Represents the department and the hospital in a positive manner.

Demonstrates professional and focused, written and verbal communication at all times and in all interactions. Demonstrates and models the AIDET framework in appropriate context and interactions.

Responsible for professional development to ensure appropriate knowledge of systems and advances in the administration of billing and collection activities. Attends seminars and reads reports and publications issued by regulatory agencies, third-party payers, etc., to maintain and display appropriate knowledge of developments to the regulatory environment and billing and collecting activities.

Identifies personal and professional areas for improvement and actively seeks out ways to meet developmental needs. Uses hospital's Core Purposes and Values as the basis for decision making and to facilitate PFS's contribution to BMC's mission. IND123

(The above statements in this job description are intended to depict the general nature and level of work assigned to the employee(s) in this job. The above is not intended to represent an exhaustive list of accountable duties and responsibilities required).

Equal Opportunity Employer/Disabled/Veterans