1200 The General Hospital Corporation
Senior Denial Analyst
1200 The General Hospital Corporation, Somerville, Massachusetts, us, 02145
Job Summary
The role is responsible for ensuring the highest quality of work through daily management of EPIC WQs, reporting, writing appeals, monitoring, and analysis. The position works within the hospital system's revenue cycle operations, specializing in resolving and preventing prior authorization denials across high‑value, high‑risk service lines. It focuses on elective surgical cases, complex outpatient procedures, infusion therapies, and emergent/urgent admissions, leveraging clinical documentation, payer policy expertise, and cross‑functional collaboration to drive financial recovery, reduce denial rates, and improve authorization workflows.
Key responsibilities include developing and monitoring qualitative and quantitative key performance indicators for the Denials team, assisting in the implementation of processes, and presenting findings to Patient Access leadership, Revenue Cycle Operations, and other MGB departments.
Essential Functions
Perform advanced data mining from Slicer/Dicer and other analytic tools to identify denial and write‑off trends; produce reports for Revenue Operations, Practices, and Prior Authorization teams.
Conduct root‑cause analysis and trend reporting to identify systemic issues and payer‑specific denial patterns; present insights and recommendations to Practices and Revenue Operations.
Collaborate with coding, clinical, registration, Prior Authorization, Revenue Operations, and Practice teams to resolve systemic issues contributing to claim denials.
Draft nuanced appeals citing clinical documentation, payer policy, and coding guidelines; identify and resolve retro authorization gaps across service lines.
Monitor compliance with organizational policies, regulatory standards, and documentation protocols; identify QA opportunities and monitor KPIs such as appeal success rates, denial overturn percentages, retro authorizations, and revenue recovery.
Prepare and present detailed reports on denial statistics and QA findings to management, highlighting areas for improvement.
Train and mentor staff on best practices for preventing denials, providing guidance on appeal strategy, write‑offs, root‑cause analysis, documentation standards, and payer compliance.
Assist in developing enhancements to existing systems related to Denials/Write‑offs, Revenue Operations, and Quality Assurance.
Recommend process improvements based on data analysis and industry best practices to enhance operational effectiveness.
Qualifications
Education:
Bachelor’s Degree in Healthcare Administration, Business, or a related field.
Experience:
3‑5 years in claims processing or denial management within a healthcare setting; 2‑3 years in denial management or healthcare compliance.
Knowledge, Skills and Abilities:
Strong analytical skills; excellent problem‑solving and attention to detail; proficiency with healthcare management software and data analysis tools; effective communication and collaboration across teams; ability to train staff on denial management processes; knowledge of healthcare regulations, compliance standards, and payer policies.
Can accept experience in lieu of a degree? Yes.
Additional Job Details
Physical Requirements: Standing (3‑33%), Walking (3‑33%), Sitting (67‑100%), Lifting 20–35 lbs (3‑33%), Carrying 20–35 lbs (3‑33%), Pushing and Pulling rarely, Balancing (3‑33%).
Remote Work Location: 399 Revolution Drive.
Scheduled Weekly Hours: 40.
Employee Type: Regular, Day Shift.
Pay Range: $78,000.00–$113,453.60 per year (Grade 7).
EEO Statement The General Hospital Corporation is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, or any other status protected by law. Reasonable accommodations will be provided as required by applicable law.
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Key responsibilities include developing and monitoring qualitative and quantitative key performance indicators for the Denials team, assisting in the implementation of processes, and presenting findings to Patient Access leadership, Revenue Cycle Operations, and other MGB departments.
Essential Functions
Perform advanced data mining from Slicer/Dicer and other analytic tools to identify denial and write‑off trends; produce reports for Revenue Operations, Practices, and Prior Authorization teams.
Conduct root‑cause analysis and trend reporting to identify systemic issues and payer‑specific denial patterns; present insights and recommendations to Practices and Revenue Operations.
Collaborate with coding, clinical, registration, Prior Authorization, Revenue Operations, and Practice teams to resolve systemic issues contributing to claim denials.
Draft nuanced appeals citing clinical documentation, payer policy, and coding guidelines; identify and resolve retro authorization gaps across service lines.
Monitor compliance with organizational policies, regulatory standards, and documentation protocols; identify QA opportunities and monitor KPIs such as appeal success rates, denial overturn percentages, retro authorizations, and revenue recovery.
Prepare and present detailed reports on denial statistics and QA findings to management, highlighting areas for improvement.
Train and mentor staff on best practices for preventing denials, providing guidance on appeal strategy, write‑offs, root‑cause analysis, documentation standards, and payer compliance.
Assist in developing enhancements to existing systems related to Denials/Write‑offs, Revenue Operations, and Quality Assurance.
Recommend process improvements based on data analysis and industry best practices to enhance operational effectiveness.
Qualifications
Education:
Bachelor’s Degree in Healthcare Administration, Business, or a related field.
Experience:
3‑5 years in claims processing or denial management within a healthcare setting; 2‑3 years in denial management or healthcare compliance.
Knowledge, Skills and Abilities:
Strong analytical skills; excellent problem‑solving and attention to detail; proficiency with healthcare management software and data analysis tools; effective communication and collaboration across teams; ability to train staff on denial management processes; knowledge of healthcare regulations, compliance standards, and payer policies.
Can accept experience in lieu of a degree? Yes.
Additional Job Details
Physical Requirements: Standing (3‑33%), Walking (3‑33%), Sitting (67‑100%), Lifting 20–35 lbs (3‑33%), Carrying 20–35 lbs (3‑33%), Pushing and Pulling rarely, Balancing (3‑33%).
Remote Work Location: 399 Revolution Drive.
Scheduled Weekly Hours: 40.
Employee Type: Regular, Day Shift.
Pay Range: $78,000.00–$113,453.60 per year (Grade 7).
EEO Statement The General Hospital Corporation is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, or any other status protected by law. Reasonable accommodations will be provided as required by applicable law.
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