Denial Prevention Process Improvement Specialist I

Denial Prevention Process Improvement Specialist

As a member of the Denial Prevention Team, the Denial Prevention Process Improvement Specialist will drive continual improvement efforts to prevent insurance rejections and related write offs. Responsible for analyzing, designing, and implementing process improvement initiatives to enhance the quality of patient care, operational efficiency, and patient safety by identifying areas for improvement, streamlining processes, and promoting a culture of continuous improvement within the hospital.

Essential Functions :

• Utilize knowledge of revenue cycle and hospital operations to interpret denial data, identify trends and translate findings into actionable prevention strategies.
• Analyze existing denial prevention healthcare processes, workflows, and procedures to identify inefficiencies, bottlenecks, and areas for improvement.
• Develop and implement performance metrics and key performance indicators to measure process effectiveness and track improvement initiatives.
• Lead or participate in quality improvement projects to optimize patient care, patient safety, and healthcare outcomes.
• Gather and analyze data related to process performance, patient outcomes, and other quality-related indicators to inform improvement efforts.
• Conduct root cause analysis to identify the underlying factors contributing to process issues or adverse events.
• Collaborate with cross-functional teams to design and implement redesigned processes that are efficient, standardized, and aligned with best practices.
• Facilitate change management efforts to ensure successful implementation of process improvements and promote staff buy-in.
• Continuously monitor and evaluate the effectiveness of implemented improvements and make adjustments as needed.

Qualifications :

Remote Type : Remote

Work Location : 399 Revolution Drive

Scheduled Weekly Hours : 40

Employee Type : Regular

Work Shift : Day (United States of America)

Pay Range : $62,400.00 - $90,750.40 / Annual

Grade : 6

EEO Statement : Mass General Brigham Incorporated is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and / or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.

The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth.