Analyst, Denials Management

📋 Description

• • CorroHealth is seeking a highly analytical and detail-oriented Analyst, Denials Management to join our dynamic Denials Management team. This pivotal role is instrumental in supporting our clients' financial health by meticulously reviewing, analyzing, and estimating reimbursement across a spectrum of denials, including clinical, technical, and DRG-related issues. You will be at the forefront of ensuring revenue integrity and optimizing our clients' financial outcomes through insightful data analysis and strategic collaboration.
• • As an Analyst, Denials Management, your primary responsibility will involve the daily reconciliation and estimation of client transactions. This includes ingesting and meticulously comparing daily client transaction files against our internal systems, such as Prism and Escort, as well as against our worked account inventories. Your expertise will be crucial in accurately estimating expected reimbursements and determining the precise invoiceable amounts for each account, payer, and denial type. You will then translate these complex estimations into clear, actionable files or dashboards for our Invoicing team, providing comprehensive rationale and detailing all underlying assumptions.
• • A significant aspect of this role involves deep dives into denials management. You will conduct thorough reviews of clinical and technical denials, with a particular focus on DRG downgrades. Applying your understanding of payer policies and historical outcomes, you will estimate the likelihood and timing of reimbursement for these denied claims. This proactive approach allows us to identify cases that require immediate escalation, such as those involving medical necessity disputes, coding edits, or DRG validation issues, and to coordinate effectively with our appeals or clinical review teams to drive resolution.
• • Beyond daily operations, you will play a key role in financial forecasting and reporting. This includes developing and maintaining robust monthly and quarterly cash and reimbursement forecasts, segmented by payer, facility, and portfolio levels. You will be responsible for tracking variances against these forecasts, continuously refining your assumptions based on observed trends in win rates, overturn rates, average days to pay, and partial approval percentages. Furthermore, you will build and present recurring reporting packages and compelling visual aids, utilizing tools like Excel and Power BI, for leadership and Finance stakeholders.
• • A critical function of this position is the analysis of payer trends. You will actively monitor payer behavior to identify systemic delays, recurring edits, coding challenges, and evolving policy changes. Quantifying the financial impact of these trends and recommending effective mitigation strategies will be a key deliverable. You will also be tasked with surfacing and analyzing trends in approval rates, common denial reasons, DRG downgrade patterns, and overall recovery cycles, providing valuable insights to inform strategic decisions.
• • Data quality and process improvement are paramount. You will be responsible for validating the integrity of incoming files, ensuring precise alignment of account identifiers, transaction types, and adjustments. You will collaborate closely with our Product and IT teams to drive enhancements in Prism and Escort, and to maintain data hygiene. Documenting Standard Operating Procedures (SOPs) for repeatable analyses will ensure consistency and efficiency across the team.
• • This role offers a unique opportunity to contribute directly to CorroHealth's mission of helping clients exceed their financial health goals. By leveraging your analytical acumen and deep understanding of revenue cycle dynamics, you will help solve programmatic needs, enable data-guided solutions, and ensure accountability in achieving client objectives. We are committed to fostering your professional development and personal growth, believing that your success is intrinsically linked to our own. Join us in building long-term careers in an environment that cultivates both professional and personal advancement.