Job Information
Atrium Health Denial Analyst - Atrium Health Professional Billing in Charlotte, North Carolina
Accepting applicants from the following states: AL, CO, FL, GA, ID, KS, KY, ME, MI, NC, SC, VA, VT
Job Summary
Performs system wide analysis of denial trends and proactively research ways to improve operating margins. Communicates denial prevention program results and barriers to system finance executive leadership.
Essential Functions
Collects, mines and analyzes the diverse data elements and sources to support various initiatives throughout the System.
Maintains and supports various databases, spreadsheets and dash boarding reports.
Collects, evaluates, analyzes and coordinates the review of financial and clinical information.
Manages key data sources and data applications.
Prepares clear and concise data reports to for senior leadership and others as required.
Ensures the integrity of project data by monitoring and validating the extraction, processing, storage and manipulation of the information.
Develops or customizes programs, methodologies, models and files for analysis, presentation and illustration of data.
Serves as a resource for data analysis, report content, report design, etc. as needed.
Evaluates and maintains the proper level of data integrity within the denial mitigations databases.
Supporting claims denials reductions and increased revenues through process redesign, root cause analysis, and development of metrics and reports.
Tracks and analyzes denial data to identify, recommend, and implement opportunities to secure legitimate revenue for the organization. Identifies trends or patterns that impact payment optimization, and collaborates with departments to establish action plans, initiatives, and policies to reverse negative denial patterns.
Analyzes and reviews third party payer denial of medical claims and develops and executes strategies to decrease denials system wide to optimize revenue.
Identifies revenue opportunities and provides appropriate investigation, follow up and resolution. Implements plans and partners with Managed Care Contracting to ensure proper adherence to contracts that does not affect revenue generation.
Generates, and audits various revenue, financial, statistical and/or quality reports surrounding the denial prevention area of focus.
Physical Requirements
Ability to sit for long periods of time. Work in safe manner. Ability to be flexible, work as part of a team and work at a fast pace when necessary.
Education, Experience and Certifications
High school degree or GED required.
Preferred:
Bachelor's Degree or equivalent knowledge. Finance, Healthcare Finance, Accounting, Audit or related field. Typically requires 3 years of experience in medical billing, healthcare finance, accounting, internal audit and/or coding that includes experience in identifying problems and opportunities for improved workflows, developing processes and procedures to reduce denials, and consulting with leadership on complex denial issues.