Denial and Prepayment Analyst na CommonSpirit Health

CommonSpirit Health at Home is a full-service health care organization that believes the best place for someone to get better is in their own home. As a faith-based organization, we are committed to finding new ways to improve the health of our patients and the health of the communities we serve. Rooted in humankindness, our ministry is at the heart of everything we do and can be seen in every patient we touch.

Candidates must reside in one of the approved remote worker states:  AR, AZ, CO, FL, GA, IA, IL, IN, KY, MI, NC, ND, NE, NJ, OH, SC, TN, TX, UT, WI.

At CommonSpirit Health at Home, we strive to embody our mission of delivering hope and healing to those we serve. The Denial and Prepayment Analyst is responsible for the coordination, submission, tracking, and reporting of pre-claim and post payment audits for all lines of business. This position will manage Additional Development Requests (ADR),  PreClaim Review (PCR) post payment audits and coordinate all resources involved through the use of clinical and  financial applications and tools. They will be responsible for reporting data and statistics related to delayed, retracted,  and partial payments or denials. Develops and delivers education to various process participants as part of continuous  process improvement. 

Responsibilities:

• Support CommonSpirit Health at Home’s mission and values by ensuring high standards of customer service and compassionate care.
• Adhere to the Corporate Compliance Program, maintaining strict confidentiality of all protected health information (PHI) in accordance with HIPAA regulations.
• Responsible for coordinating the timely response of all documentation requests and audits through coordination between all involved departments including Compliance, Operations and Revenue Cycle. Provides feedback to Operations, Compliance, and Revenue Cycle staff for evaluation of current  workflows and processes and determine education solutions to improve denial ratios. 
• Provides accurate and timely reporting of Additional Development Requests (ADR), PreClaim Review (PCR)  and Post-payment Audits through use of Revenue Cycle applications. 
• Evaluates current applications and makes recommendations on functionality and enhancements to  current product.  
• Serves as member of implementation team, for new applications as well as new releases on existing  applications, as a Subject Matter Expert, providing guidance and support to ensure that best practice  processes and workflows are taken into account and included in testing plans. 
• All other duties as assigned

Benefits:

• Generous annual bonus structure that rewards your hard work!
• Excellent Vacation Plan, Paid Holidays, and Personal Time
• Medical, Dental, and Vision Plans
• Tuition Reimbursement
• Fidelity 401(K) Plan

• Candidates must reside in one of the approved remote worker states:  AR, AZ, CO, FL, GA, IA, IL, IN, KY, MI, NC, ND, NE, NJ, OH, SC, TN, TX, UT, WI.

• High School diploma or equivalent.
• Five years of healthcare, home infusion or ancillary service experience, preferably in Revenue Cycle.
• Experience as a front line user and intermediary to other departments of vendors in one or more of the following applications: HCHB, CPR+, McKesson Horizon or RescueNet/Zoll.
• Excellent time management skills with the ability to self-direct and handle multiple tasks/projects simultaneously.
• Detail oriented and organized
• Preferred: Associates degree in Accounting/Finance or related field

At CommonSpirit Health at Home, we are proud to be an Equal Opportunity Employer, promoting diversity, equity, and inclusion in every aspect of our organization. We value the unique contributions of all individuals, including minorities, protected veterans, and individuals with disabilities.