Denial and Prepayment Analyst
About Us
Inspired by faith. Driven by innovation. Powered by humankindness. CommonSpirit Health is building a healthier future for all through its integrated health services. As one of the nation’s largest nonprofit Catholic healthcare organizations, CommonSpirit Health delivers more than 20 million patient encounters annually through more than 2,300 clinics, care sites and 138 hospital-based locations, in addition to its home-based services and virtual care offerings.
Our Mission
As CommonSpirit Health, we make the healing presence of God known in our world by improving the health of the people we serve, especially those who are vulnerable, while we advance social justice for all. To learn more about a calling that defines and unites, please click here for more information about our mission, vision, and values.
The posted compensation range of $21.73 - $29.87 /hour is a reasonable estimate that extends from the lowest to the highest pay CommonSpirit in good faith believes it might pay for this particular job, based on the circumstances at the time of posting. CommonSpirit may ultimately pay more or less than the posted range as permitted by law.
Candidates must reside in one of the approved remote worker states: AR, AZ, CO, FL, GA, IA, IL, IN, KY, MI, NC, ND, NE, NJ, OH, SC, TN, TX, UT, WI.
At CommonSpirit Health at Home, we strive to embody our mission of delivering hope and healing to those we serve.The Denial and Prepayment Analyst is responsible for the coordination, submission, tracking, and reporting of pre-claim and post payment audits for all lines of business. This position will manage Additional Development Requests (ADR), PreClaim Review (PCR) post payment audits and coordinate all resources involved through the use of clinical and financial applications and tools. They will be responsible for reporting data and statistics related to delayed, retracted, and partial payments or denials. Develops and delivers education to various process participants as part of continuous process improvement.
Responsibilities:
- Support CommonSpirit Health at Home’s mission and values by ensuring high standards of customer service and compassionate care.
- Adhere to the Corporate Compliance Program, maintaining strict confidentiality of all protected health information (PHI) in accordance with HIPAA regulations.
- Responsible for coordinating the timely response of all documentation requests and audits through coordination between all involved departments including Compliance, Operations and Revenue Cycle. Provides feedback to Operations, Compliance, and Revenue Cycle staff for evaluation of current workflows and processes and determine education solutions to improve denial ratios.
- Provides accurate and timely reporting of Additional Development Requests (ADR), PreClaim Review (PCR) and Post-payment Audits through use of Revenue Cycle applications.
- Evaluates current applications and makes recommendations on functionality and enhancements to current product.
- Serves as member of implementation team, for new applications as well as new releases on existing applications, as a Subject Matter Expert, providing guidance and support to ensure that best practice processes and workflows are taken into account and included in testing plans.
- All other duties as assigned
Benefits:
- Generous annual bonus structure that rewards your hard work!
- Excellent Vacation Plan, Paid Holidays, and Personal Time
- Medical, Dental, and Vision Plans
- Tuition Reimbursement
- Fidelity 401(K) Plan
Job Requirements
- Candidates must reside in one of the approved remote worker states: AR, AZ, CO, FL, GA, IA, IL, IN, KY, MI, NC, ND, NE, NJ, OH, SC, TN, TX, UT, WI.
- High School diploma or equivalent.
- Five years of healthcare, home infusion or ancillary service experience, preferably in Revenue Cycle.
- Experience as a front line user and intermediary to other departments of vendors in one or more of the following applications: HCHB, CPR+, McKesson Horizon or RescueNet/Zoll.
- Excellent time management skills with the ability to self-direct and handle multiple tasks/projects simultaneously.
- Detail oriented and organized
- Preferred: Associates degree in Accounting/Finance or related field
At CommonSpirit Health at Home, we are proud to be an Equal Opportunity Employer, promoting diversity, equity, and inclusion in every aspect of our organization. We value the unique contributions of all individuals, including minorities, protected veterans, and individuals with disabilities.
Where You'll Work
CommonSpirit Health at Home is a full-service health care organization that believes the best place for someone to get better is in their own home. As a faith-based organization, we are committed to finding new ways to improve the health of our patients and the health of the communities we serve. Rooted in humankindness, our ministry is at the heart of everything we do and can be seen in every patient we touch.
Depending on the position offered, CommonSpirit Health offers a generous benefit package, including but not limited to medical, prescription drug, dental, vision plans, life insurance, paid time off (full-time benefit eligible team members may receive a minimum of 14 paid time off days, including holidays annually), tuition reimbursement, retirement plan benefit(s) including, but not limited to, 401(k), 403(b), and other defined benefits offerings, as may be amended from time to time. For more information, please visit https://www.commonspirit.careers/benefits.
Unless directed by a Collective Bargaining Agreement, applications for this position will be considered on a rolling basis. CommonSpirit Health cannot anticipate the date by which a successful candidate may be identified.
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Equal Opportunity
CommonSpirit Health™ is an Equal Opportunity/Affirmative Action employer committed to a diverse and inclusive workforce. All qualified applicants will be considered for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, marital status, parental status, ancestry, veteran status, genetic information, or any other characteristic protected by law. For more information about your EEO rights as an applicant, please click here.
CommonSpirit Health™ will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c). External hires must pass a post-offer, pre-employment background check/drug screen. Qualified applicants with an arrest and/or conviction will be considered for employment in a manner consistent with federal and state laws, as well as applicable local ordinances, ban the box laws, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances. If you need a reasonable accommodation for any part of the employment process, please contact us by telephone at (415) 438-5575 and let us know the nature of your request. We will only respond to messages left that involve a request for a reasonable accommodation in the application process. We will accommodate the needs of any qualified candidate who requests a reasonable accommodation under the Americans with Disabilities Act (ADA). CommonSpirit Health™ participates in E-Verify.