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Research Denial Prevention Specialist - Remote

Company: Conifer Health Solutions
Location: Portland
Posted on: January 16, 2022

Job Description:

As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step!

Job Summary

This Research and Analysis position is responsible for ensuring claims and denials are efficicently and effectively functioning, and assess Operational Processes for risks in the Revenue Cycle that lead to Denials and Write-offs. The Denials Researcher will be the main conduit for identifying opportunity for the Denial Prevention and Operations teams to facilitate continuous improvement. Revenue Cycle wide knowledge is needed to assess and optimize Scheduling, Financial Clearance, Clinical Care Management, Coding, Billing, Follow Up and Appeal processes are working effectively and efficiently to reduce denial write offs

Critical responsibilities include: (a) providing research and and analysis findings to support Denial Prevention to assess training and process needs in the Markets and Business Office processes, (b) Review and analyze claim denials, providing root cause trending to Denial Prevention and Operations; and (c) Review Key Performance Indicators by practice against research findings

Essential Duties And Responsibilities

Include the following. Others may be assigned. Denial Research -- Serve as primary conduit for analyzing denial data, operational processes, and accounts that fall out, leading to Denials and Revenue Loss. Assess and monitor Operational processes that contribute to Denials, providing data trending, processes observations, and level remediation feedback to Denial Prevention. Interacts with Denials Management and other key sponsors, presents a knowledgeable, efficient, and professional image by handling business in a respectful and professional demeanor, and excel in the following activities:
Company Advisor - Rise to the level of trusted advisor within Conifer, with an eye on performance.
Reporting and Analytics- Prepare and present to Operational performance trending, gaps, and next steps as appropriate
Relationship Management -- Facilitate and maintain relationships through regular, pro-active communication, timely follow-through on requests and coordination of resources to meet Conifer needs
Effectively communicate data or technical concepts with detail to Prevention and Operations. Strong proficiency with Excel, Access, Powerpoint along with superior Verbal and written communication skills.
Ability to review and churn through a large number of accounts, identifying the critical areas of focus over non-impactful misses for prioritization and focus. Identify any emerging analytic needs for stakeholders to monitor impact and process gaps.
Defining issues; identifying root causes; interpreting data; understanding data dependencies; goal setting; establishing tracking and reporting metrics; updating project plans; leader of denial subcommities; providing performance reports and deliverable preparation
As needed, provide project management support, analysis, and/or technical expertise for a broad array of Revenue Cycyle initiatives. Has responsibility for assisting teams in support of Regional or National Analysis and Research
Company Policy. Adheres to all company policies and procedures including, but not limited to those identified within the Standards of Business Conduct and the Employee Handbook, as may be amended from time to time. Adheres to all applicable laws and regulations and the company's governance/compliance program. Responsible for reporting violations of the company's policies and procedures, Standards of Business Conduct, Compliance, governance program, laws and regulations through the company's Help Line or other mechanism that may be available at the time of the violation. Assists with internal control failure remediation efforts.Relationship Management -- Facilitate and maintain relationships through regular, pro-active communication, timely follow-through on requests and coordination of resources to meet client needs

FINANCIAL RESPONSIBILITY (varies by client site)

Qualifications

KNOWLEDGE, SKILLS, ABILITIES

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Requires an understanding of systems and processes that impact revenue cycle performance and capabilities.
Possesses the ability to build trusting relationships with Operational Leaders
Possesses analytical ability sufficient to work in a data-heavy environment and to identify trends in the data.
Possess business acumen with an emphasis on research and then soft skills, such as effective communication, problem solving, decision making and time management skills.
Intermediate MS Office required (Outlook, Excel, Word, and PowerPoint).

Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings.

Education / Experience

Include minimum education, technical training, and/or experience preferred to perform the job.
Three to Five years in Revenue Cycle or Acute Health Care
Demonstrated experience of the entire acute care hospital revenue cycle processes is required
Understanding the risks that lead to Denials and the ability to trend
Exposure to project management to include developing and implementing business initiatives, change management, and bringing together disparate team members to successfully deliver client solutions

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Must be able to work in sitting position, use computer and answer telephone
Ability to travel although not required
Includes ability to walk through hospital-based departments across broad campus settings, including Emergency Department environments

WORK ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Office Work Environment
Hospital Work Environment

TRAVEL
None

Job: Conifer Health Solutions

Primary Location: Frisco, Texas

Job Type: Full-time

Shift Type: Days

Keywords: Conifer Health Solutions, Portland , Research Denial Prevention Specialist - Remote, Other , Portland, Oregon

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