Denials Management Business Analyst in Altamonte Springs, FL at Adventist Health System

Date Posted: 11/9/2018

Job Snapshot

  • Job Schedule
  • Job Category
  • Date Posted:
  • Job ID:
  • Job Function
  • Travel
    Yes, 50 % of the Time
  • Shift
    1 - Day
  • AHS Zone
    1-Shared Services
  • Organization
    Adventist Health System Corporate Office

Job Description

Work Hours/Shift

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 Business Analyst provides analytical expertise to help run denials management department effectively and efficiently. Role involves collection of data in relation to billing, accounts receivable, denials, underpayments, appeals and audits. Respective data will need to be interpreted and analyzed.  Based on findings and insights, the analyst will convert data into meaningful financial, management and statistical reports that help maintain healthy operations and support special denials management projects. In addition, to analyzing the current state of operation utilizing the data, this position will need to be able to leverage data analytics to perform trend projections, identify opportunities for operational and financial improvement, increase reimbursements, reduce denials, and identify denial root causes. Adheres to AHS Compliance Plan and to all rules and regulations of all applicable local, state and federal agencies and accrediting bodies.

What you will be responsible for:
  • Collects data from multiple sources as needed and is able to determine how to unify into a single data set when needed to complete necessary analyses
  • Analyzes 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 trends, etc.
  • Reports on daily operational statistics as requested by leadership (Supervisors, Managers, and Directors), key findings, insights and recommendations to respective counterparts and plays an active role if requested in any and all A/R Management, Billing, and Denials Management related group forums
  • Spearheads denials management prevention projects by gathering and analyzing data needed to support process improvement
  • Develops and maintains department dashboards and distributes reports to appropriate audiences. This includes departmental KPIs and reports, executive dashboards, staff productivity and quality reports, etc.
  • Monitors CARC/RARC code mapping for trends by payor and updates mapping based on identified trends as directed by leadership.
  • Responsible for developing data visualizations to allow for quick insight and understanding
  • Responsible for designing and maintaining reports for daily reconciliation of accounts and variances between patient accounting system and denials workflow & reporting platforms.
  • Responsible for monitoring and maintaining reports deployed on the denials management platform. This includes handling update requests, access issues, and deployment of new reports as needed.
  • Responsible for managing and maintaining denial workflow and reporting tool, including work queue configuration
  • 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 higher
  • 2+ years’ experience in data reporting applications
  • Strong quantitative, analytical and organization skills
  • Proficiency in data warehousing and business intelligence platforms
  • Ability to understand insurance terms and payment methodologies
  • Ability to navigate accounts to perform research and gather additional information to identify root causes

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.

Location | Organization | Category | Job Function