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UNC Health · 1 month ago

PFS Denials Prevention Analyst

Hendersonville, NC

Full-time

Onsite

Mid Level

3+ years exp

UNC Health is an inclusive organization dedicated to improving the health and well-being of unique communities. The Denials Prevention Analyst plays a crucial role in identifying and mitigating denial risks within the healthcare revenue cycle, collaborating with various departments to develop strategies that reduce denials and ensure compliance with billing regulations.

Addiction TreatmentHealth CareHealth DiagnosticsHospitalNon ProfitWellness

Responsibilities

Perform root cause analysis on denied accounts to identify high dollar and high-volume denials

Identify trends impacting payment optimization and collaborate with internal and external departments to decrease system-wide denials

Review adjustments based on Denial Write-Off Approval Levels, providing feedback to users

Establish and monitor key performance indicators, developing standardized reporting and presenting denial reports to leadership

Evaluate denial appeal practices and educate on best practices for responding to denials, ensuring necessary documentation is included

Participate in Denial Committee, focusing on denial prevention activities and performance improvement

Compile monthly reports and dashboards on avoidable write-offs, monitoring key performance indicators for performance improvement activities

Partner with Managed Care to ensure adherence to contracts and communicate updates on billing guidelines and payment policies

Identify and track areas of revenue leakage, submitting corrected claims and tracking for additional payment

Collaborate with the Denials Management Team to provide information for resolving denials and create educational materials on process improvements

Demonstrate understanding of federal, state, and third-party charging guidelines, analyzing revisions to coding and billing regulations

Participate in in-services and organizational meetings, utilizing lean management tools and continuing education programs

Qualification

Denial experienceRegulatory knowledgeCPT/APC/HCPCS codingData presentationReport creationResearch skillsOrganizational skillsInterpersonal skillsCritical thinkingCommunication skillsProblem-solving skills