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Denials Systems Analyst-AR Management (Hosp)

MetroHealth

Cleveland, OH

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JOB DETAILS
SKILLS
Accounts Receivable Management, Affordable Housing, Analysis Skills, Auditing, Best Practices, Billing, Business Operations, Certified Coding Specialist (CCS), Communication Skills, Community Health, Computer Science, Corrective Action, Current Procedural Terminology (CPT), Data Analysis, Decision Support, Disease Prevention and Control, Emergency Care, Environmental Economics, Establish Priorities, Finance, Financial Analysis, Financial Services, Government, Healthcare, Healthcare Common Procedure Coding System (HCPCS), Hospital, Housekeeping/Cleaning, ICD-10, Information Technology & Information Systems, Interpersonal Skills, Legal, Maintain Compliance, Medical Billing, Medical Coding, Medical Records, Medical Terminology, Medical Treatment, Microsoft Access Database, Microsoft Excel, Microsoft Office, Microsoft Word, Multitasking, Operational Audit, Operational Improvement, Operations Management, Performance Management, Presentation/Verbal Skills, Problem Solving Skills, Process Development, Process Improvement, Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Regulatory Compliance, Reimbursement, Revenue Management, Root Cause Analysis, Safety/Work Safety, System Operations, Systems Analysis, Trend Analysis, Writing Skills
LOCATION
Cleveland, OH
POSTED
3 days ago
Location: MetroHealth Old Brooklyn Campus

Biweekly Hours: 80.00

Shift: 8am-4:30pm

The MetroHealth System is redefining health care by going beyond medical treatment to improve the foundations of community health and well-being: affordable housing, a cleaner environment, economic opportunity and access to fresh food, convenient transportation, legal help and other services. The system strives to become as good at preventing disease as it is at treating it. Founded in 1837, Cuyahoga County's safety-net health system operates four hospitals, four emergency departments and more than 20 health centers.

Summary:

Responsible for leading the implementation, design, and ongoing support of all Patient Financial Services functional areas. Ensures efficient and effective business office operations through continuous monitoring of workflows, identifying process gaps, and analyzing opportunities for operational improvement while maintaining awareness of current industry best practices. Provides comprehensive support for all denial management functions by conducting root-cause analysis of denied claims, recommending corrective actions, and driving process improvements to reduce future denials. Oversees decision-making for claim submissions and appeals across commercial and government payers, maintaining up-to-date knowledge of evolving payer requirements and ensuring organizational compliance. Develops, maintains, and analyzes a wide range of denial management reports to support strategic decision-making, operational transparency, and performance improvement across the revenue cycle.

Qualifications:

Required:

  • Bachelor's degree in Business, Finance, Computer Science, or Healthcare related field.
  • In lieu of degree, two years of experience working in a related role in Revenue Cycle.
  • Analytical ability to extract and synthesize relevant data supporting trends and report to team members with varying knowledge levels and coding familiarity.
  • Demonstrated ability to create charts, presentations, and reports utilizing Microsoft Office suite, Word, Excel, and Access. Ability to manage, organize, prioritize, and multitask.
  • Excellent problem solving, interpersonal, written, and verbal communication skills.
  • Ability to interact effectively with a wide range of cultural, ethnic, racial, and socioeconomic backgrounds.


Preferred:

  • Three years of data or financial analysis experience.
  • Three years of experience in revenue management, patient financial services or health information systems.
  • Three years of experience of reimbursement/payment policies, medical terminology, medical record coding, claim billing and auditing or in working with regulatory and policy compliance issues related to federal and state programs.
  • Expertise in data extraction and database queries.
  • Active coding certification (e.g., RHIA, RHIT, CPC, CCS).
  • Extensive knowledge of medical codes, including ICD-10-CM, CPT, HCPCS, and E/M.

About the Company

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MetroHealth