Mass General Brigham · 1 day ago
Senior Denial Analyst
United States
Full-time
Remote
Mid, Senior Level
$78K/yr - $113K/yr
3+ years expMass General Brigham is a not-for-profit organization dedicated to advancing patient care and medical research. The Senior Denial Analyst role focuses on managing denial resolutions within the revenue cycle operations, ensuring compliance, and driving financial recovery through analysis and collaboration with various departments.
Health CareHome Health CareMedical
Responsibilities
Performs advanced data mining from Slicer /Dicer (Revenue, denials, write-offs) and other data analytic tools to identify denial and write-off trends and works with Revenue Operations, Practices, and Prior Authorization teams to create daily, weekly, or monthly reports as needed
Performs root cause analysis and trend reporting to identify systemic issues and payer-specific denial patterns, and analyzes denial and write-off trends; presents monthly reports to Practices and Revenue Operations with actionable insights and recommendations for prevention
Collaborates and serves as liaison with coding, clinical, registration, Prior Authorization, Revenue Operations, and Practice teams to resolve and address systemic issues contributing to claim denials
Independently drafts nuanced appeals citing clinical documentation, payer policy, and coding guidelines; identifies and resolves retro authorization gaps across service lines
Monitors compliance with all organizational policies, regulatory standards, and documentation protocols; identifies QA opportunities for Prior Authorization and Practice teams, and monitors KPIs such as appeal success rates, denial overturn percentages, retro authorizations, and revenue recovery
Prepares and presents detailed reports on denial statistics and QA findings to management, highlighting areas for improvement
Trains and mentors staff on best practices for preventing denials, providing guidance and training to analysts on appeal strategy, write-offs, root cause analysis, documentation standards, and payer compliance, while fostering team development
Assists in the development of enhancements to existing systems related to Denials /Write-offs, Revenue Operations, and Quality Assurance
Recommends process improvements based on data analysis and industry best practices to enhance overall operational effectiveness, such as the development of reusable appeal templates, the use of artificial intelligence, retro-auth reporting, and troubleshooting guides to streamline team operations and reduce rework
Qualification
Required
Bachelor's Degree Healthcare Administration required or Bachelor's Degree Business required or Bachelor's Degree Related Field of Study required
Experience in claims processing, denial management, or quality assurance within a healthcare setting 3-5 years required
Experience in denial management and/or healthcare compliance 2-3 years required
Strong analytical skills to interpret data and identify trends
Excellent problem-solving abilities and attention to detail
Proficient in using healthcare management software and tools for data analysis
Effective communication skills for collaborating with cross-functional teams
Ability to train and educate staff on denial management processes
Knowledge of healthcare regulations, compliance standards, and strong knowledge of payer policies
Benefits
Comprehensive benefits
Career advancement opportunities
Differentials
Premiums and bonuses as applicable
Recognition programs designed to celebrate your contributions and support your professional growth
Company
Mass General Brigham
Mass General Brigham specializes in providing medical treatments and health diagnostics services.
10001+ employees
H1B Sponsorship
Mass General Brigham has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (77)
2024 (61)
2023 (93)
2022 (70)
2021 (80)
2020 (29)
Funding
Current Stage
Late StageLeadership Team
E
Erin Flanigan
SVP, Human Resources, Community, Specialty Hospital Division
O’Neil A. Britton
Chief Integration Officer, Executive Vice President
Recent News
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