Denial Prevention Analyst | Avera Heart Hospital

Denial Prevention Analyst

Avera Heart Hospital, isn't just a place to work, it's a family. Our 650 employees are what make the difference in our care and why we are one of the only few hospitals out of 4,000 nationwide to achieve a double 5-star rating from the Centers for Medicare and Medicaid (CMS). Be apart of something great!

Position Highlights

Position Summary

The Denial Prevention Analyst coordinates facility wide denial and denial prevention information for Avera Heart Hospital and North Central Heart. This individual will be responsible for reviewing Patient Access, HIM, and Business Office denials trends in order to identify and implement prevention opportunities. Furthermore, the Denial Prevention Analyst works accounts in Denial Management desktop to provide resolution, writes and submits professionally written appeals which include compelling arguments based on clinical documentation, third-party payer medical policies, and contract language. Appeals are submitted timely and tracked through final outcome.

Work Schedule

Monday - Fridays 8-5pm.

Education/Experience

Bachelor's degree preferred. Four years of revenue cycle, billing, third-party payer, managed care, prior authorization or denials required. Knowledge of payer requirements, regulatory guideline, and hospital reimbursement methodologies. Experience standardizing revenue cycle processes and implementing best practices workflows.