The Opportunity:

CAREER OPPORTUNITY OFFERING:

• Bonus Incentives

• Paid Certifications

• Tuition Reimbursement

• Comprehensive Benefits

• Career Advancement

• The salary range for this position is $69,000.00 to $104,100.00. Final offers are based on experience and geo zone.

­­­­The Denial Prevention Process Improvement Advisor leads the performance of deep dive analysis on clinical and technical denials for his or her respective client, utilizing multiple analytics tools (including parsed 835 data, Epic BDC records, Access databases/SQL) to identify patterns and trends relative to acute denials. The Denial Prevention Process Improvement Advisor applies high level problem-solving skills to perform root cause analysis on denied accounts as transactions and extrapolates those causes across large volumes identified as denial trends for assigned facilities. The Denial Prevention Process Improvement Advisor then uses process improvement expertise and persuasion skills to guide and influence subject matter experts through assessments of operations and preparation of policies, procedures, and tip sheets that assist in remedying the root cause(s).

The Denial Prevention Process Improvement Advisor is client-facing and oversees completion of denial prevention committee reports and summaries for assigned hospitals, attends monthly denial prevention committee meetings, liaises as primary contact for assigned client on revenue cycle related-denials issues, establishes and maintains client relationships to drive best practice implementations, and utilizes sound judgment and experience to aggregate and advance team recommendations for correcting underlying issues impacting denials. This is done in facilitation and addition to an expectation of contributing to the overarching goals of the Payment Integrity Team and Ensemble as a whole.

Essential Job Functions:

• Provides relevant guidance and works to resolve issues escalated by Revenue Cycle Site Directors, and other participants related to denial prevention

• Leads monthly Denial Prevention onsite week kick-off and close-out meetings with assigned client leadership, covering necessary information relative to identified trends, progress from prior actions, and next steps.

• Establishing strong relationships with appropriate stakeholders/committee members, including Finance Leadership, Revenue Cycle, Managed Care, and hospital ancillary department heads

• Oversees documentation and trends prevention-related findings into defined templates, initiating or creating reports or summaries as needed.

• Leads reviews using all patient accounting, host, Epic and related systems used across their client to verify and summarize trends concisely and actionably.

• Aggregates and provides strategic advisory perspective related to process improvement and quality in assessment of the root cause issues creating denials by working with the subject-matter experts and applicable owners to make recommendations to remedy process, system, and education issues.

• Creates materials and trains denial prevention staff, revenue cycle site directors, committee members, and revenue cycle staff as necessary on denials-related trends and issues impacting their client.

• Performs other duties as assigned

Required Minimum Education:

• 4 year/ Bachelors Degree

Specialty/Major:

• Healthcare administration, Business or related discipline

Preferred Education:

• Graduate Degree (Masters)

Required Knowledge, Skills and Abilities:

• Project Work, Intermediate Excel & Access Skills
• Project Management, Data Analytics
• Demonstrated advanced usage of AI and the management of teams using AI to lean into process and technological improvements, to include the exploration, experimentation, and application of AI.
• This is a remote position; however, candidates must be willing and able to travel to and work onsite at client, temporary, or corporate office locations as business needs require.

Licensure/Certification Preferred:

• Certified Specialist Managed Care (CSMC); LEAN Six Sigma Black Belt
• Certified Revenue Cycle Representative: (CRCR)

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