Denial Reduction & Analytics Manager

Cook Children's Health Care System•Fort Worth, TX

13d•Onsite

About The Position

The Manager of Denial Reduction and Analytics provides operational and technical direction to Revenue Integrity, Patient Access, Patient Financial Services (PFS), and the Central Business Office (CBO). The role provides expertise in denial reduction and in processes that prevent denials, working with finance and clinical departments to improve workflows and support staff. The manager develops denial trending, reporting, and root-cause analysis to support strategic analysis and decision-making; creates documentation for training and troubleshooting system problems; and oversees the use of tools to reduce and prevent denials. The role also develops reporting and analytics best practices, reviews payer denial patterns, and works with clinical operations, Payor Relations, and revenue cycle departments to provide leadership with analytic tools, including ad-hoc queries and reports for Revenue Cycle and Finance teams. Cook Children’s is an equal opportunity employer. It is a Texas-only employer; hired employees must maintain their primary residence in Texas and keep all required licenses and credentials current throughout employment.

Requirements

Five years of hospital or physician revenue cycle or financial analysis experience.
Ability to apply appropriate supervisory, management, and leadership techniques in an operational setting.
Excellent ability to understand and interpret statistical reports and perform quantitative analysis.
Knowledge of Information Systems principles sufficient to analyze information and make decisions effectively.
Excellent written and oral communication skills to communicate effectively with top leadership.
Knowledge of healthcare-related financial and/or accounting practices.
Problem-solving skills across a variety of settings and ability to translate data into actionable steps.
Ability to deal effectively with constant changes and act as a change agent.
Detailed knowledge of health plan operations, reimbursement methodologies, payer contracts, and clinical policies.
Knowledge of state, federal, and compliance regulations as they apply to coding and billing processes and procedures.

Nice To Haves

Bachelor’s degree in Health Care Administration, Business, Accounting, Finance, or a related field preferred.
Three years of experience in a leadership role preferred.
Prior experience with Epic Systems Revenue Cycle Solutions preferred.

Responsibilities

Provide operational and technical direction to Revenue Integrity, Patient Access, Patient Financial Services, and the Central Business Office.
Provide guidance and input on denial-related activities, including registration, financial clearance and authorization, coding, charging, and billing.
Develop denial trending, reporting, and root-cause analysis to support strategic analysis and decision-making.
Create documentation to support training and help troubleshoot system problems.
Oversee the use of appropriate tools to reduce and prevent denials.
Serve as a technical leader and provide in-depth expertise in denial reduction efforts and processes that prevent denials.
Work with finance and clinical departments to continually improve processes and avoid denials through optimal use of standardized workflows.
Participate in mentoring staff who support these functions.
Develop best practices for reporting and analytics to identify opportunities, problems, process improvements, and system changes.
Assist with ongoing review of payer denial patterns as needed.
Work closely with clinical operations, Payor Relations, and revenue cycle departments to provide leadership with analytic tools, including ad-hoc queries and reports for Revenue Cycle and Finance teams.