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Denial Prevention Coordinator / PAS Administration

Requisition ID:

21159187

Business Unit:

Hartford HealthCare Corp.

Location:

Newington, CT

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Description

Job Schedule: Full Time
Standard Hours: 40
Job Shift: Shift 1
Shift Details: Monday through Friday

Work where every moment matters.

Every day, almost 30,000 Hartford HealthCare colleagues come to work with one thing in common: Pride in what we do, knowing every moment matters here. We invite you to become part of Connecticut’s most comprehensive healthcare network.

The creation of the HHC System Support Office recognizes the work of a large and growing group of employees whose responsibilities are continually evolving so that we and our departments now work on behalf of the system as a whole, rather than a single member organization.
With the creation of our new umbrella organization we now have our own identity with a unique payroll, benefits, performance management system, service recognition programs and other common practices across the system.

JOB SUMMARY:

Responsible for internal revenue cycle and external institute/service line and acute care site collaboration in an effort to holistically reduce our professional and hospital primary denial rates, reducing relative revenue cycle rework costs and increasing cash flow.  Performs and provides detailed analysis in all aspects of the Revenue Cycle to identify data trends and root cause to recognize opportunities and stand up denial prevention subgroups to develop creative solutions to mitigate the root cause of the denial at hand, enhancing current and developing new processes.  Prepares and presents denial data to key stakeholders within the institutes/service lines, including directors and above, to increase visibility to preventive denial trends and actively engage to achieve intended denial reduction outcomes.  Focuses on relationship building with process stakeholders.  Partner with our IT teams and third party vendors to identify opportunity to customize the Epic system to further reduce opportunity for denials.  Monitors system flow and processes between departments.  Responsible for developing and assimilating standard work and user education as needed.  Maintains current knowledge of payor and federal guidelines and industry wide denial trends. 

RESPONSIBILITIES:

  • Proposes denial prevention initiatives, identifies stakeholders and builds relationships, consolidates, prepares, and analyzes data, facilitates denial prevention subgroup meetings to engage participants, and drive desired results, and brings forth creative solutions to identified preventable denial trends.
  • Analyzes denial and write off data, identifies irregular reporting patterns, and performs high level root cause analysis.
  • Develops SBARs, standard work, and user education documents.
  • Collaborates with IT to implement customized systemic modifications to our Epic system to reduce preventable denials.

This Job Reports to Denial Prevention Manager.

Qualifications

QUALIFICATIONS:

Education

Bachelor’s Degree in healthcare management, medical or business related area.  Graduate degree preferred.

Experience

5+ years of denials management/denials prevention experience

3-5 years of revenue cycle analytics experience

Licensure, Certification, Registration

Coding certification or clinical background

Knowledge, Skills and Ability Requirements 

  • Strong business writing skills.
  • Superior communication, organizational, and analytical skills.
  • Ability to communicate effectively and build relationships with process stakeholders, including directors and above.
  • Demonstrated experience in collaborating with both clinical and administrative colleagues.
  • Ability to effectively use data to prioritize tasks and efforts.
  • Knowledge of clinical denials and resolution process.
  • Vast understanding of Hospital and Professional revenue cycle.
  • Ability to identify and communicate payer and/or system trends.
  • Ability to effectively identify themes and trends in data.  
  • Knowledge of payer contracts, regulations and guidelines, as well as State and Federal laws relating to billing and collection procedures.
  • Proficient with medical and insurance terminology.
  • Proficient in the use of a computer and relevant hospital software applications.
  • Understanding and adherence to HIPAA Regulations and Release of Information Rules.
  • Models teamwork through cooperation and collaboration within and outside the work group.
  • Ability to attain productivity and quality standards per department requirements.

We take great care of careers.

With locations around the state, Hartford HealthCare offers exciting opportunities for career development and growth. Here, you are part of an organization on the cutting edge – helping to bring new technologies, breakthrough treatments and community education to countless men, women and children. We know that a thriving organization starts with thriving employees-- we provide a competitive benefits program designed to ensure work/life balance. Every moment matters. And this is your moment.

 
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