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Denial Management Analyst Job in Cleveland, Ohio US

Job Summary

University Hospitals Health System
Cleveland, OH
Government and Military
Job Type
Full Time
Years of Experience
2+ to 5 Years
Job Reference Code

Denial Management Analyst

About the Job


As a Denial Management Analyst this role collaborates and coordinates with all members of the health care team, patient and family (or significant others) to coordinate and ensure timely and efficient delivery of required workflow, services and tasks to result in:

*Support of positive patient health care outcomes
*Increased patient/health care team outcomes and satisfaction
*Improved communication, awareness and adherence to regulatory requirements associated with clinical documentation and coding.
*Support for best practice provider documentation in order to decrease clinical and coding validation denials
*Continuity and coordination of care
*Decreased denials on the basis of clinical and coding validation
*Appropriate reimbursement

1.Perform timely and accurate review of denials, appeal determination and submission, including tracking findings and outcomes in the designated software tool.  Remain current with regulatory / payer and internal requirements.

2.Collaborate with physicians, coders, CDI specialists, insurance follow-up and other members of the Interdisciplinary team and Revenue Cycle to collect all pertinent information and create effective appeals to support successful outcomes, including communication of trends and appropriate escalation to ensure appropriate resolution resulting in expected payment.

3.Document appeal activity according to department standards to support accurate and timely reporting of denial and appeal status, outstanding revenue and to help identify trends and educational feedback focused on denial prevention (payer, physician, service, DRG, diagnosis, reviewer).

4.Collaborate with CDI and Coding leadership teams and Physician Advisors to support feedback, training, and reinforcement resulting in decreased denials.

5.Conduct all denial review activities with a focus on continuous quality improvement in a manner that is supportive of UH quality initiatives and in compliance with applicable regulatory requirements.

*This role may encounter Protected Health Information (PHI) as part of regular responsibilities.  UH employees must abide by all requirements to safely and securely maintain PHI for our patients.  Annual training, the UH Code of Conduct and UH policies and procedures are in place to address appropriate use of PHI in the workplace.


*Bachelor's or Associate's Degree in Nursing or Health Information Management required.

Credentials, License and/or Certifications:
*RN with current license to practice in the State of Ohio or Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT) required.
*Certification in Clinical Documentation Improvement and/or Coding Certification preferred

Experience & Knowledge:
*3+ years of experience in inpatient coding and/or CDI required, preferable at an academic medical center. Must have sound clinical knowledge base of the population to be served and up-to date working knowledge of current industry clinical guidelines required.
*Experience with ICD-10 coding guidelines
*Knowledge of Medicare, Medicaid and commercial payer regulations preferred.Special Skills & Equipment Knowledge:
*Must be detail-oriented and organized, with good analytical and problem solving ability.
*Notable client service, communication, presentation and relationship building skills required.
*Ability to function independently and as a team player in a fast-paced environment required.
*Must have strong written and verbal communication skills.
*Demonstrated ability to use PCs, Microsoft Office suite, and general office equipment (i.e. printers, copy machine, FAX machine, etc.) required.
*Demonstrated ability to apply concepts, utilize sound judgment and work independently within a framework of guidelines required.
*Coding software proficiency preferred.

Equal Opportunity Employer – minorities/females/veterans/individuals with disabilities/sexual orientation/gender identity

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