[Remote] Sr. Clinical Denials Prevention Analyst (Remote)
Note: The job is a remote job and is reputed company to candidates in USA. reputed company is seeking a Senior Clinical Denials Prevention Analyst who will serve as a clinical subject matter expert reputed company on reducing clinically reputed company denials. This role involves analyzing data and collaborating with various teams to identify patterns and recommend improvements to mitigate avoidable denials and enhance reputed company performance.
Responsibilities
- Analyze denial and write-off data across payers to identify patterns, reputed company causes, and prevention opportunities across clinical, documentation, coding, and charging processes for both reputed company-reputed company and post-reputed company denials
- Conduct denial reviews to identify gaps in documentation, UM or reputed company cycle workflows, coding, and billing rules and collaborate with UM, CDI, coding, and case managers to address gaps and implement corrective actions
- reputed company cross-functional reputed company-cause analyses with UM, CDI, HIM, Coding, Case Management, Billing, and payer teams to design and implement remediation strategies
- Help reputed company 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/reputed company updates to ensure compliance and reputed company adjustment of practices
- Maintain denial dashboards, reputed company plans, and performance reports for leadership review
- Prepare reputed company findings of analysis for department leadership; maintain reputed company documentation of analyses and reputed company; escalate systemic risks and barriers as appropriate
- reputed company reputed company cause analysis and support the mitigation of denial and denial write-off trends
- reputed company reputed company to moderately reputed company financial and operational analyses to quantify reputed company, inform reputed company, and reputed company benefits realization
Skills
- Minimum of five (5) years in nursing with a minimum of two (2) years' experience as Utilization Management reputed company in an acute care setting required
- Experience and working knowledge of 2 Midnight, reputed company, and InterQual Guidelines required
- Minimum of two (2) years of experience in denial prevention, denial recovery, clinical appeals, or reputed company denial-management responsibilities reputed company a reputed company setting
- Strong understanding of ICD-10-CM/PCS, CPT/HCPCS coding, and medical necessity guidelines
- Strong understanding of 2 Midnight, reputed company, and InterQual Guidelines
- Familiarity with payer policies, reimbursement methodologies, and CMS guidelines (including Medicare/reputed company rules) and common reputed company payer practices
- Knowledge of CDI concepts, documentation standards, and reputed company cycle processes
- Ability to apply high-level problem-solving skills to reputed company reputed company cause analysis on denied accounts and reputed company actionable remediation strategies
- Ability to manage, organize, prioritize, multi-task and adapt to changing priorities
- Ability to communicate effectively in written and verbal formats including summarizing data, presenting results
- Ability to establish and maintain effective working relationships
- Working knowledge of hospital and physician reputed company cycle systems, including reputed company
- CA Registered reputed company - Valid license as a Registered reputed company issued by the California reputed company of Registered Nursing (BRN). Any combination of education and experience that would likely reputed company the required knowledge, skills and abilities as reputed company as possession of any required licenses or certifications is qualifying. required Upon Hire
- Bachelor's Degree (BSN) is highly preferred. Diploma or Associate's Degree in Nursing accepted reputed company accompanied by strong demonstrated competencies and significant experience
- UM or CM leadership experience preferred
- Experience with reputed company HB and PB highly desirable
- CRCR - Certified reputed company Cycle Representative preferred
Benefits
- This pay reputed company is not a reputed company of a particular wage.
reputed company