Denials Management Operations Analyst

Join us as we work to create a thriving ecosystem that delivers accessible, high-quality, and sustainable healthcare for all.

Position Summary:

The Denials Management Operations Analyst is responsible for analyzing a queue of work related to revenue cycle success. This includes working claims escalated from our business partners and/or other health insurance claim-based work excluded from our standard workflows. Following established workflows and identified best practices, you will research and resolve claims to support the creation of a thriving ecosystem that delivers accessible, high-quality, and sustainable healthcare for all.   Your responsibilities will include analysis and appropriate resolution of a queue of work within a contractually specified timeframe in the most efficient manner possible, identifying trends through observation and investigation, and escalating opportunities for improvement to the appropriate business unit. You are detail oriented, with a focus on work efficiency and quality. You possess a collaborative mindset and a desire to achieve subject matter expertise in your assigned area of work. You have critical thinking skills and are process improvement driven.  

About the Team:

The Rejection and Denial Analysis team empowers athenahealth to deliver industry-leading clean claim performance by identifying and investigating the drivers of rejections and denials, delivering and managing a robust, cross-functional feedback loop of data-driven opportunities that enable effective prevention and management.

Essential Job Responsibilities:

60% Queue Based Work 

• Ensures accurate entry of information into athenaNet and trading partner applications.

• Builds and maintains expert subject matter knowledge of assigned processes in order to be a resource for clients and internal stakeholders

• Works with key stakeholders (internal and/or external) across geographies to perform tasks

• Removes obstacles and works independently to ensure completion of assigned tasks within specified turnaround times and adhering to established goals

• Prioritizes work effectively in a fast-paced environment

• Demonstrates flexibility & adaptability when business directives change

• Possesses a high level of attention to detail and holds self to equally high-quality standards

• Embodies athenahealth’s values and behaviors

• Leverages all available resources to solve problems

20% Trend Identification/Critical Thinking & Problem Solving

• Identifies and surfaces workflow inconsistencies

• Communicates opportunities for innovation and process refinement

• Evaluates alternative methodologies when applicable and implements appropriate solutions to new problems

• Presents information and concepts in a professional and organized manner

• Leverages all available resources to solve problems

• Identify error trends in your work and escalate where appropriate

• Navigate the organization with professionalism

20% Training & Professional Development

• Participates in training opportunities by leveraging appropriate growth

• Shares useful information and guidance with teams

• Accepts, delivers and implements both positive and constructive feedback

• Demonstrates behaviors of our Values

• Engages in dialogue to facilitate trust and understanding of others

• Initiates opportunities to experience and learn new skills in support of personal career development

• Provides training & mentoring to peers to ensure client needs are met and work is completed accurately

• Becomes an engaged and active participant in athenahealth’s teaching and learning culture by demonstrating tenacity and teamwork

• Demonstrates commitment to becoming a subject matter expert

Expected Education & Experience:

• Bachelor’s degree preferred or 2-4 years of professional experience preferred

• Effective communication and business writing skills

• Microsoft Office Suite, basic computer skills including proficient typing and navigation

• Effective communication and interpersonal relationship skills

• Solid planning and organizational abilities

• Time management skills and ability to prioritize work based on criticality

• Critical thinking and problem-solving skills

• Works independently as well as part of an extended, cross-functional team

• Experience working with cross-functional groups and teams to achieve common goals

• Flexibility and adaptability in approach to challenges to achieve desired outcomes

• Displays initiative, tenacity and flexibility in a fast-paced team environment

• Attention to detail

Expected Compensation

The base salary range shown reflects the full range for this role from minimum to maximum. At athenahealth, base pay depends on multiple factors, including job-related experience, relevant knowledge and skills, how your qualifications compare to others in similar roles, and geographical market rates.  Base pay is only one part of our competitive Total Rewards package - depending on role eligibility, we offer both short and long-term incentives by way of an annual discretionary bonus plan, variable compensation plan, and equity plans.