Denials Prevention Analyst

• Conducts in-depth analysis of denial data (volume, reason codes, payer type, service line, etc.) to identify patterns, trends, and underlying root causes of denials.
• Develops and implement data-driven strategies and process improvements to proactively prevent future claim denials and optimize the revenue cycle.
• Collaborates with key stakeholders across the revenue cycle and clinical departments (e.g., Billing, Coding, Clinical Documentation Improvement, Case Management, Utilization Management, Front Desk) to identify denial risks, implement preventative measures as well as opening and monitoring Epic related tickets to resolve denial issues.
• Stays informed on evolving payer policies, government regulations (Medicare, Medicaid), and industry best practices relating to denial prevention and management, sharing with all impacted areas as appropriate.
• Manages and prioritizes a caseload of complex and escalated denied claims, requiring advanced problem-solving and appeal strategy development to include researching, preparing, and submitting comprehensive appeals to insurance payers, gathering necessary documentation, crafting persuasive arguments, and ensuring adherence to payer-specific requirements and deadlines.
• Serves as the primary point of contact for complex denial inquiries from internal staff, providers, and payers, providing guidance and support to resolve issues.
• Coordinates with legal counsel, Compliance, clinical leaders and physicians on high priority denial cases requiring advanced clinical or legal review.
• Organizes and facilitates denial prevention workgroups and meetings, ensuring clear communication, action item tracking and follow up on process improvement initiatives.
• Provides targeted education and training to revenue cycle staff, clinical teams, and other relevant personnel on coding changes, documentation requirements, payer specific guidelines, and denial prevention strategies.
• Develops and maintain denial tracking tools, dashboards, and reports to monitor key performance indicators (KPIs) related to denial rates, appeal success, and financial impact for the BTNRH Revenue Cycle leaders as well as Executive team members.
• Monitors and analyzes all Epic follow-up work queues focused on timeliness and overall financial health and performance, reporting back as necessary when issues are found to the appropriate leaders.
• Performs quarterly Professional Billing payer reimbursement audits, reporting back findings with under and over payments to the Revenue Cycle leaders as well as escalating with the appropriate payer reps, monitoring until resolved and opening tickets to modify the Epic Payer Contract build when necessary.
• Serves as the primary conduit between Insurance Follow-up and Coding as it relates to denials and the work done within the Revenue Cycle in an effort to more effectively work and avoid payer denial issues.

• Proven analytical skills, including the ability to interpret complex data, identify trends, perform root cause analysis, and develop effective solutions.
• Strong knowledge of medical billing, coding (ICD-10, CPT, HCPCS), payer policies and healthcare regulations.
• Experience with electronic health record (EHR) systems (e.g., EPIC, Cerner) and denial management/analytics platforms.
• Strong organizational skills, attention to detail, and ability to manage multiple priorities in a fast-paced environment.
• Collaborative mindset with the ability to work effectively across departments and with external payers.
• Proficiency in Microsoft Office Suite (Excel, Word, PowerPoint) for data analysis and reporting.

• Bachelor's degree in healthcare administration, Business, Finance, or related field or equivalent combination of education and experience required.
• Minimum of 7 years of experience in healthcare revenue cycle, with a strong focus on denial prevention, analysis, and management required.
• Expertise in third party payers and WPS reason and remark codes required.

• Relevant certifications such as Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or Certified Revenue Cycle Representative (CRCR) are highly preferred.

• Other Duties: This job description incorporates the essential functions and duties required for this position. However, other duties may be required and assigned at times and as determined by a supervisor in order to meet the needs of the organization.

• Serves as a role model in carrying out activities and behaviors that reflect the values and principles of the Boys Town mission.

• Position is relatively sedentary in a normal office administrative environment involving minimum exposure to physical risks. Will use office equipment such as a computer/laptop, monitor, keyboard, and a general workstation set-up.

Care and respect for others is more than a commitment at Boys Town - it is the foundation of who we are and what we do.

At Boys Town, we cultivate a culture of belonging for all employees that respects their individual strengths, views, and experiences. We believe that our differences enable us to be a better team - one that makes better decisions, drives innovation, and delivers better business results.

About Boys Town:

Boys Town has been changing the way America cares for children and families since 1917. With over a century of service, our employees have helped us grow from a small boardinghouse in downtown Omaha, Nebraska, into one of the largest national child and family care organizations in the country. With the addition of Boys Town National Research Hospital in 1977, our services branched out into the health care and research fields, offering even more career opportunities to those looking to make a real difference.

Our employees are our #1 supporters when it comes to achieving Boys Town's mission, which is why we are proud of their commitment to making the world a better place for children, families, patients, and communities. A unique feature for employees and their dependents enrolled in medical benefits are reduced to no cost visits for services performed by a Boys Town provider at a Boys Town location. Additional costs savings for the employee and their dependents are found in our pharmacy benefits with low to zero-dollar co-pays on certain maintenance drugs. Boys Town takes your mental health seriously with no cost mental health visits to an in-network provider. We help our employees prepare for retirement with a generous match on their 401K or 401K Roth account. Additional benefits include tuition assistance, parenting resources from our experts and professional development opportunities within the organization, just to name a few. Working at Boys Town is more than just a job, it is a way of life.

This advertisement describes the general nature of work to be performed and does not include an exhaustive list of all duties, skills, or abilities required. Boys Town is an equal employment opportunity employer and participates in the E-Verify program. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and/or expression, national origin, age, disability, or veteran status. To request a disability-related accommodation in the application process, contact us at 1-877-639-6003.