Sign upLog in

Care Management-Denials and Appeals Analyst-Robinson Building-40 Hours Days Monday-Friday

Boston Medical Center

Boston, MA

Apply
JOB DETAILS
SKILLS
Analysis Skills, Clinical Data Collection, Clinical Information Systems, Communication Skills, Conferences, Customer Support/Service, Data Analysis, Data Collection, Data Quality, Editing, Entrepreneurship, Epic Certification, Epic Systems, Hospital, Hospital Systems, Infection Control, Medical Billing, Medical Records, Microsoft Access Database, Microsoft Excel, Microsoft Office, Microsoft PowerPoint, Microsoft Word, Multitasking, Patient Care, Patient Rights, Performance Analysis, Presentation/Verbal Skills, Process Improvement, Quality Management, Quality Metrics, Reporting Dashboards, Reporting Skills, Root Cause Analysis, Safety Process, Statistics, Strategic Planning, Time Management, Trend Analysis, Writing Skills
LOCATION
Boston, MA
POSTED
30+ days ago
POSITION SUMMARY:

This position will work closely with the UM/Appeals Director to ensure the monitoring and reporting of performance standards that include UM/MD Advisor/Appeal productivity. In addition, the Senior UM/clinical Denials/MDA Data Analyst will assist in generating reports from the clinical management systems, such as Epic, in addition to Access Databases currently utilized. The Senior Data Analyst coordinates data collection, analysis, data validation, audits and dissemination of reports and assists with other operations related projects. This position will also likely include Epic training and certification (for the purpose of report creation and editing).

Position: Care Management/Denials and Appeals Analyst

Department: Robinson Building

Schedule: 40 Hours Days Monday-Friday

ESSENTIAL RESPONSIBILITIES / DUTIES:
  • Participates in the development and implementation of data collection tools, ensure accuracy of data collected from clinical records and other sources and standardized measures. Work effectively with colleagues internally and externally to ensure that deadlines are met for data submission to various internal and external stakeholders
  • Meets with various revenue-generating departments to communicate root causes of denial and provides direction to mitigate denials in the future.
  • Responsible for supporting revenue cycle denial prevention for hospital billing by analyzing data, requesting and monitoring reports, and maintaining dashboards to aid in the identification and strategic planning of denial prevention initiatives which includes education of ongoing denial prevention efforts, denial trends, and root cause analysis.
  • Produces materials, new reports and assists in training denial prevention staff as necessary on denials-related trends and issues impacted.
  • Submits to manager process improvement recommendations to remedy process, system, and education issues.
  • Produces ad hoc and special reports upon request for administrative, clinical and educational utilization.
  • Manages, maintain and report on audit recovery processes for state, federal and local payers
  • Manages, maintain and report on new hospital pilot program initiatives
  • Data analytic support for all departments within the Care Management department
  • Ensures professional growth and development through participation in conferences and educational workshops and maintaining knowledge of data quality standards and practices.
  • Conforms to hospital standards of performance and conduct, including those pertaining to patient rights, so that the best possible customer service and patient care may be provided.
  • Utilizes hospital's RESPECT attributes as the basis for decision making and to support the hospital's mission and goals
  • Follows established hospital infection control and safety procedures.
  • Other duties may involve assisting with departmental tasks and projects as required to bring department to an efficient and well-functioning unit.

JOB REQUIREMENTS

EDUCATION:
  • Bachelor's degree or equivalent experience in a related practice

EXPERIENCE:
  • 5+ years experience in a similar clinical setting or 5+ years experience working with statistical data or quality improvement processes

KNOWLEDGE AND SKILLS:
  • Demonstrated proficiency in Microsoft Office platform-Word, Access, Excel, PowerPoint; E-mail. Web/Internet. Proficiency in Epic and other generally used hospital applications
  • Excellent oral and written communication skills
  • Ability to prepare high quality ad hoc and routine reports according to established timelines
  • Ability to work independently, take initiative, meet deadlines and handle multiple priorities in entrepreneurial, dynamic fast paced environment
  • Must be able to maintain strict confidentiality of all personal/health sensitive information
  • Ability to present data through graphs and charts
  • Ability to be flexible in changing requests with short notice

Req id: 31460

About the Company

B

Boston Medical Center