Note: The job is a remote job and is open to candidates in USA. Stanford Health Care is seeking a Senior Denials Prevention Analyst to support healthcare revenue cycle operations. The role analyzes denial trends, identifies root causes, leads cross-functional prevention initiatives, monitors KPIs and revenue impact, and maintains dashboards and leadership reports to reduce denials and ensure payer compliance.
Responsibilities
- Perform revenue cycle denial analytics to trend issues, identify root causes, and prioritize denial prevention opportunities
- Conduct targeted account sampling and case reviews to validate findings and help define corrective actions
- Prepare concise analytics summaries, denial prevention related PowerPoints and reports, and leadership readouts of workgroup findings
- Lead and facilitate cross-functional discussions; connect interdependent topics across workgroups to align solutions
- Build and maintain action plans with clear owners, timelines, and success metrics; document minutes, key takeaways, and next steps; distribute follow-up communications, reports, and analytics to attendees
- Monitor denial prevention KPIs, initiative progress, and associated revenue impact; explain fluctuations and escalate barriers
- Lead cross-functional root cause analysis with Patient Access, Patient Financial Clearance, UM/CM, CDI, HIM/Coding, Clinical Operations, and PFS to identify workflow, system, policy, and education changes needed to prevent denials and monitor progress on implementation of remediation strategies
- Help develop and implement denial prevention strategies, workflows, and playbooks and monitor their effectiveness through regular KPI reporting
- Monitor payer policy changes, national guidelines, and CMS/Medicare/Medicaid updates to ensure compliance and timely adjustment of practices
- Maintain denial dashboards, action plans, and performance reports for leadership review
- Prepare denial reports and summary findings of analysis for department leadership; maintain clear documentation of analyses and outcomes; escalate systemic risks and barriers as appropriate
Skills
- High school diploma (or GED equivalent)
- Five (5) years of progressively responsible and directly related work experience
- Denial prevention, denial management, prior authorization, or revenue cycle specific experience
- Two (2) years' experience in denial prevention, denial recovery, prior auth, registration, coding, or denial management related role within a healthcare setting
- 1-2 years of statistical analysis experience
- Domain experience across 2+ of the following areas: PAS, PFC, HIMS, Revenue Integrity, Coding, Professional Billing and Follow-up, Hospital Billing and Follow-up, Denial Prevention, Denial Management/Recovery, or Payment Compliance
- Working knowledge of government and non-government payer requirements, reimbursement rules, laws, and regulations that govern billing/collection activities
- Working knowledge of Epic Hospital and/or Professional Billing; strong proficiency in Epic reporting, especially Slicer/Dicer, and the ability to translate data into actionable insights
- Ability to analyze and develop solutions to complex problems, including independently identifying problems through data analysis
- Ability to analyze information, reach valid conclusions and make sound recommendations
- Ability to manage, organize, prioritize, multi-task and adapt to changing priorities
- Working knowledge of medical terminology, CPT-4, ICD-9/ICD-10, HCPCS, and modifiers, and how these items drive reimbursement
- Analytical and problem-solving skills, with good judgment, attention to detail, and thorough follow-through
- Excellent verbal and written communication skills; ability to present complex data clearly to stakeholders
- Ability to communicate effectively in written and verbal formats including summarizing data, presenting results to senior leadership
- Ability to establish and maintain effective working relationships
- Knowledge of Microsoft Office software, including strong knowledge of Excel including but not limited to proficient with functions such as VLOOKUP, IF, IS, and macro commands for automation
- CPC - Certified Professional Coder required
- CRCR - Certified Revenue Cycle Representative required
- Bachelor's degree in a work-related field/discipline from an accredited college or university
- Advanced reporting capabilities such as tableau, Power BI, SQL, etc. preferred
Benefits
- Remote work arrangement
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