Sr. Business Systems Analyst - Denials Management
We are hospitals and affiliated medical groups, working closely together for the benefit of every person who comes to us for care. We build comprehensive networks of quality healthcare services that are designed to offer our patients highly coordinated, personalized care and help them live healthier lives. Through collaboration, we strive to provide all of our patients and medical group members with the quality, affordable healthcare they need and deserve.
The Sr. Business System Analyst, Denials Management identifies opportunities to enhance revenue cycle processes, reduce denials, manage length of stay (LOS) and creates analytics that will provide consultation to all facilities. Specific focus will be on decreasing LOS, increasing collections, reducing and preventing denials, reducing bad debt, and reducing revenue leakage in the form of missed charges, underpayments, and denials. Helps manage the Prospect (East or West) denials reporting and root cause identification alongside the Director of Revenue Optimization and the National Vice President of Revenue Optimization. Coordinates national reporting with Assigned Local and National Analytics Team and also supports local CFOs and COO with pertinent data. Conducts thorough analysis on reimbursement data to create reports identifying trends by payer, by physician, by department, by product line, and individual staff members within the organization.
- Builds solid relationships with senior level Revenue Cycle and Operations leadership. Understands multifaceted business problems and develops analytical solutions to complex issues.
- Partners with internal and external stakeholders in key business areas related to Denials Management, LOS Management, and Revenue Operations to create technology solutions for workflow and reporting.
- Quickly identifies performance gaps based on current/future reporting capabilities and works with facility leadership to define action plans and track ongoing process improvements and financial impact.
- Mines patient and healthcare provider data from multiple sources, including patient accounting data, claims data, clinical data from electronic medical records, to discover key analytical insights for revenue cycle, operational improvement team, and finance.
- Continuously monitors reports and dashboards and/or build out new innovative metrics to track productivity, quality and results of the revenue cycle.
- Assists facility level analysts in maintaining current facility, regional and national dashboards, while continuing to strive for metric standardization across the organization. Functions as a coach and mentor to facility level analysts; ensures quality performance measurement across all dashboards.
- Partners with Case Management and other Clinical Resources to identify trends, barriers and process or workflow gaps.
Minimum Education: Bachelor's Degree in business, IT, accounting, healthcare administration or Equivalent Experience. Master's Degree preferred.
Minimum Experience: Five (5) years of experience working in an analytical, reporting or data management/consulting role in the healthcare industry. Knowledge of third-party payer regulations, reimbursement, and payment policies. Knowledge of ICD.10, CPT-4 and HCPCS coding, as well as CMS-1500 and UB-04 forms. Understanding of Revenue Operations and Clinical workflows. Ability to read, write and communicate effectively in English. Ability to maintain a work pace appropriate to the workload. Demonstrated ability to critically think about data trends and translate data into decisions. Demonstrated ability to analyze, extract, and identify data issues with large data sets. Proven analytic and problem-solving skills. Strong interpersonal skills and the ability to work collaboratively. Proficiency in utilizing Microsoft Excel and other database management software. Ability to self-manage and prioritize multiple tasks. Tableau & SQL proficiency preferred.
Req. Certification/Licensure: None.
Employee Value Proposition
Prospect Medical Holdings, Inc., is guided by a diverse and highly experienced leadership core. This group maintains the vision that has made Prospect a needed difference-maker in the lives of so many patients today, and many executives contribute to our continued efforts. As a member of our highly effective team of professionals you will receive:
- Company 401K
- Medical, dental, vision insurance
- Paid time-off
- Life insurance
How to Apply
To apply for this role, or search our other openings, please visit http://pmh.com/careers/ and click on a location to begin your journey to a new career with us!
We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources.
EEOC is the Law: https://www1.eeoc.gov/employers/poster.cfm
Keywords: Systems, Analyst, Hospitals, ICD.10, CPT-4, HCPCS coding, CMS-1500, UB-04 forms, SQL, Tableau, Excel, Healthcare, Data Management, reporting, accounting, revenue cycle, Denials.