Denial Prevention Analyst II
YOU were meant for Hopkins.
What Awaits You?
• Career growth and development
• Diverse and collaborative working environment
• Generous Paid Time Off
• Tuition Reimbursement
• Affordable and comprehensive benefits package
This is a remote role- Applicants working from MD, DC, VA, PA, DE and FL will be considered.
Summary:
Responsible for analyzing denied claims, identifying root causes, and preparing reports on denial trends. Reviews claims, corrects errors, and maintains compliance with payer policies and regulatory requirements. Collaborates with other departments to resolve denial issues and supports training efforts to improve claims submission practices. Assists in appeals management, utilizes data analytics tools to track denial trends, and participates in process improvement initiatives to reduce denials. Researches and recommends process improvements, automation and system functionality to improve workflows across the revenue cycle.
Key Responsibilities:
• Analyze denied claims to identify root causes, payer-specific trends, and opportunities for process improvement.
• Conduct regular audits of claims, adjustments, and write-offs to ensure accuracy and identify trends requiring intervention.
• Facilitate or participate in denial prevention meetings, ensuring follow-up on action items and tracking progress to resolution.
• Review and assess claims for accuracy, completeness, and compliance prior to submission to minimize denial risk.
• Maintain detailed documentation of denial cases, resolutions, and appeal outcomes to support tracking and reporting.
• Oversee and maintain denial prevention workgroup trackers, ensuring clear documentation of action plans, ownership, and timelines.
• Assist in the preparation of professional monthly denial reports and executive-level presentations, highlighting key trends, risks, and performance metrics.
• Review departmental workflows to identify revenue leakage, operational inefficiencies, and gaps in front-end and back-end processes; recommend actionable solutions to leadership.
• Communicate denial trends, risks, and performance concerns to leadership, providing data-driven insights and recommendations
• Collaborate cross-functionally with clinical, revenue cycle, coding, and registration teams to resolve denial issues and prevent recurrence.
• Provide guidance and support to site leadership on denial prevention strategies, payer requirements, and best practices.
• Identify and recommend automation opportunities to improve efficiency, accuracy, and scalability of denial prevention processes.
• Monitor key performance indicators (KPIs) related to denials, appeals, and write-offs, ensuring accountability to organizational targets.
Required Qualifications
• Bachelor's Degree in healthcare administration, business administration, or a related field (Required)
• One year of relevant education may be substituted for one year of required work experience or one year of relevant professional-level work experience may be substituted for one year of required education.
• 2+ years of experience in denial management within healthcare revenue cycle (Required)
• Navigate rapidly changing situations, from evolving patient needs to technological advancements, by remaining flexible, continuously learning, embracing new challenges, and quickly recovering from setbacks.
• Solid written and verbal communication skills with an emphasis on confidentiality, tact, and diplomacy.
• Work assignments are varied and sometimes require interpretation.
• Strong attention to detail and self-directed to consistently ensure data integrity and accuracy.
• Uphold ethical principles by maintaining confidentiality, ensuring informed consent, and making decisions that prioritize the well-being of both patients and staff.
• Work seamlessly within diverse teams, bringing together professionals from various disciplines to provide patient-centered care and achieve collective goals.
• Ensures their work aligns with regulatory standards and company policies.
• Makes decisions that are guided by general instructions and practices requiring some interpretation.
• Addresses basic to moderately complex administrative and operational challenges.
• Applies comprehensive knowledge, skills, and practices to perform a variety of assignments in Back End Revenue Cycle Management.
• Fully functioning capacity/ working knowledge of Back End Revenue Cycle Management.
• Works on assignments within a process or set of processes of moderate size, scope, diversity, and/or complexity.
• Performs work thoroughly in a cost-efficient manner and at a high productivity level.
• Intermediate proficiency and experience using Microsoft Office Package (Excel, PowerPoint, Word, Outlook).
Salary Range: Minimum 26.51/hour - Maximum 43.76/hour. Compensation will be commensurate with equity and experience for roles of similar scope and responsibility. In cases where the range is displayed as a $0 amount, salary discussions will occur during candidate screening calls, before any subsequent compensation discussion is held between the candidate and any hiring authority.
The Hospital reserves the right to modify employee schedules as needed.
We are committed to creating a welcoming and inclusive environment, where we embrace and celebrate our differences, where all employees feel valued, contribute to our mission of serving the community, and engage in equitable healthcare delivery and workforce practices.
Johns Hopkins Health System and its affiliates are drug-free workplace employers.
What Awaits You?
• Career growth and development
• Diverse and collaborative working environment
• Generous Paid Time Off
• Tuition Reimbursement
• Affordable and comprehensive benefits package
This is a remote role- Applicants working from MD, DC, VA, PA, DE and FL will be considered.
Summary:
Responsible for analyzing denied claims, identifying root causes, and preparing reports on denial trends. Reviews claims, corrects errors, and maintains compliance with payer policies and regulatory requirements. Collaborates with other departments to resolve denial issues and supports training efforts to improve claims submission practices. Assists in appeals management, utilizes data analytics tools to track denial trends, and participates in process improvement initiatives to reduce denials. Researches and recommends process improvements, automation and system functionality to improve workflows across the revenue cycle.
Key Responsibilities:
• Analyze denied claims to identify root causes, payer-specific trends, and opportunities for process improvement.
• Conduct regular audits of claims, adjustments, and write-offs to ensure accuracy and identify trends requiring intervention.
• Facilitate or participate in denial prevention meetings, ensuring follow-up on action items and tracking progress to resolution.
• Review and assess claims for accuracy, completeness, and compliance prior to submission to minimize denial risk.
• Maintain detailed documentation of denial cases, resolutions, and appeal outcomes to support tracking and reporting.
• Oversee and maintain denial prevention workgroup trackers, ensuring clear documentation of action plans, ownership, and timelines.
• Assist in the preparation of professional monthly denial reports and executive-level presentations, highlighting key trends, risks, and performance metrics.
• Review departmental workflows to identify revenue leakage, operational inefficiencies, and gaps in front-end and back-end processes; recommend actionable solutions to leadership.
• Communicate denial trends, risks, and performance concerns to leadership, providing data-driven insights and recommendations
• Collaborate cross-functionally with clinical, revenue cycle, coding, and registration teams to resolve denial issues and prevent recurrence.
• Provide guidance and support to site leadership on denial prevention strategies, payer requirements, and best practices.
• Identify and recommend automation opportunities to improve efficiency, accuracy, and scalability of denial prevention processes.
• Monitor key performance indicators (KPIs) related to denials, appeals, and write-offs, ensuring accountability to organizational targets.
Required Qualifications
• Bachelor's Degree in healthcare administration, business administration, or a related field (Required)
• One year of relevant education may be substituted for one year of required work experience or one year of relevant professional-level work experience may be substituted for one year of required education.
• 2+ years of experience in denial management within healthcare revenue cycle (Required)
• Navigate rapidly changing situations, from evolving patient needs to technological advancements, by remaining flexible, continuously learning, embracing new challenges, and quickly recovering from setbacks.
• Solid written and verbal communication skills with an emphasis on confidentiality, tact, and diplomacy.
• Work assignments are varied and sometimes require interpretation.
• Strong attention to detail and self-directed to consistently ensure data integrity and accuracy.
• Uphold ethical principles by maintaining confidentiality, ensuring informed consent, and making decisions that prioritize the well-being of both patients and staff.
• Work seamlessly within diverse teams, bringing together professionals from various disciplines to provide patient-centered care and achieve collective goals.
• Ensures their work aligns with regulatory standards and company policies.
• Makes decisions that are guided by general instructions and practices requiring some interpretation.
• Addresses basic to moderately complex administrative and operational challenges.
• Applies comprehensive knowledge, skills, and practices to perform a variety of assignments in Back End Revenue Cycle Management.
• Fully functioning capacity/ working knowledge of Back End Revenue Cycle Management.
• Works on assignments within a process or set of processes of moderate size, scope, diversity, and/or complexity.
• Performs work thoroughly in a cost-efficient manner and at a high productivity level.
• Intermediate proficiency and experience using Microsoft Office Package (Excel, PowerPoint, Word, Outlook).
Salary Range: Minimum 26.51/hour - Maximum 43.76/hour. Compensation will be commensurate with equity and experience for roles of similar scope and responsibility. In cases where the range is displayed as a $0 amount, salary discussions will occur during candidate screening calls, before any subsequent compensation discussion is held between the candidate and any hiring authority.
The Hospital reserves the right to modify employee schedules as needed.
We are committed to creating a welcoming and inclusive environment, where we embrace and celebrate our differences, where all employees feel valued, contribute to our mission of serving the community, and engage in equitable healthcare delivery and workforce practices.
Johns Hopkins Health System and its affiliates are drug-free workplace employers.