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Sr. Denials Prevention Analyst (Remote)

Stanford Health Care
Remote, USA
Full-time
Senior · 1–2 years experience
Remote
Discovered 2 weeks ago
excelpower-bisqltableau

Full Job Posting

What you will do

  • Perform revenue cycle denial analytics to trend issues, identify root causes, and prioritize denial prevention opportunities.
  • Conduct targeted account sampling and case reviews to validate findings and help define corrective actions.
  • Prepare concise analytics summaries, denial prevention related PowerPoints and reports, and leadership readouts of workgroup findings.
  • Lead and facilitate cross-functional discussions; connect interdependent topics across workgroups to align solutions.
  • Build and maintain action plans with clear owners, timelines, and success metrics; document minutes, key takeaways, and next steps; distribute follow-up communications, reports, and analytics to attendees.
  • Monitor denial prevention KPIs, initiative progress, and associated revenue impact; explain fluctuations and escalate barriers.
  • Lead cross-functional root cause analysis with Patient Access, Patient Financial Clearance, UM/CM, CDI, HIM/Coding, Clinical Operations, and PFS to identify workflow, system, policy, and education changes needed to prevent denials and monitor progress on implementation of remediation strategies.
  • Help develop and implement denial prevention strategies, workflows, and playbooks and monitor their effectiveness through regular KPI reporting.
  • Monitor payer policy changes, national guidelines, and CMS/Medicare/Medicaid updates to ensure compliance and timely adjustment of practices.
  • Maintain denial dashboards, action plans, and performance reports for leadership review.
  • Prepare denial reports and summary findings of analysis for department leadership; maintain clear documentation of analyses and outcomes; escalate systemic risks and barriers as appropriate.
  • Education Qualifications
  • High school diploma (or GED equivalent). Required
  • Bachelor’s degree in a work-related field/discipline from an accredited college or university. Preferred

Experience

  • Qualifications
  • Five (5) years of progressively responsible and directly related work experience, with a preference for denial prevention, denial management, prior authorization, or revenue cycle specific experience.
  • Two (2) years’ experience in denial prevention, denial recovery, prior auth, registration, coding, or denial management related role within a healthcare setting.
  • 1-2 years of statistical analysis experience.
  • Required Knowledge, Skills and Abilities
  • Domain experience across 2+ of the following areas: PAS, PFC, HIMS, Revenue Integrity, Coding, Professional Billing and Follow-up, Hospital Billing and Follow-up, Denial Prevention, Denial Management/Recovery, or Payment Compliance.
  • Working knowledge of government and non-government payer requirements, reimbursement rules, laws, and regulations that govern billing/collection activities
  • Working knowledge of Epic Hospital and/or Professional Billing; strong proficiency in Epic reporting, especially Slicer/Dicer, and the ability to translate data into actionable insights
  • Ability to analyze and develop solutions to complex problems, including independently identifying problems through data analysis
  • Ability to analyze information, reach valid conclusions and make sound recommendations
  • Ability to manage, organize, prioritize, multi-task and adapt to changing priorities
  • Working knowledge of medical terminology, CPT-4, ICD-9/ICD-10, HCPCS, and modifiers, and how these items drive reimbursement
  • Analytical and problem-solving skills, with good judgment, attention to detail, and thorough follow-through
  • Excellent verbal and written communication skills; ability to present complex data clearly to stakeholders
  • Ability to communicate effectively in written and verbal formats including summarizing data, presenting results to senior leadership
  • Ability to establish and maintain effective working relationships
  • Knowledge of Microsoft Office software, including strong knowledge of Excel including but not limited to proficient with functions such as VLOOKUP, IF, IS, and macro commands for automation.
  • Advanced reporting capabilities such as tableau, Power BI, SQL, etc. preferred.
  • Licenses and Certifications
  • CPC - Certified Professional Coder required. or
  • CRCR - Certified Revenue Cycle Representative required
  • These principles apply to ALL employees:
  • SHC Commitment to Providing an Exceptional Patient & Family Experience
  • Stanford Health Care sets a high standard for delivering value and an exceptional experience for our patients and families. Candidates for employment and existing employees must adopt and execute C-I-CARE standards for all of patients, families and towards each other. C-I-CARE is the foundation of Stanford’s patient-experience and represents a framework for patient-centered interactions. Simply put, we do what it takes to enable and empower patients and families to focus on health, healing and recovery.
  • You will do this by executing against our three experience pillars, from the patient and family’s perspective:
  • Know Me: Anticipate my needs and status to deliver effective care
  • Show Me the Way: Guide and prompt my actions to arrive at better outcomes and better health
  • Coordinate for Me: Own the complexity of my care through coordination

Preferred Qualifications

  • Advanced reporting capabilities such as tableau, Power BI, SQL, etc. preferred.

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