What are the responsibilities and job description for the Data Analyst Denials Mgt position at McLaren Port Huron?
About Us
McLaren Health Care is a fully integrated health network committed to quality, evidence-based patient care with locations in Michigan and Indiana. The McLaren system includes 13 hospitals in Michigan, ambulatory surgery centers, imaging centers, a primary and specialty care physician network, commercial and Medicaid HMOs, home health, infusion and hospice providers, pharmacy services, a clinical laboratory network and a wholly owned medical malpractice insurance company. McLaren operates Michigan’s largest network of cancer centers and providers, anchored by the Karmanos Cancer Institute, one of only 53 National Cancer Institute-designated comprehensive cancer centers in the U.S.
Data Analyst Denials Mgt
Michigan, Port Huron
NEW
Non-Health Professional
McLaren Port Huron
25000382
Position Summary: Under general supervision, facilitates report generation and detailed statistical data compilation from various healthcare applications and outcome reports and/or analysis while maintaining data integrity and quality through system management activities. Provides CM, UM and Denial management data for strategic planning, decision support, outcomes analysis, information exchange, comparative data analyses, resource allocation, credentialing, and health policy decisions.
Essential Functions and Responsibilities as Assigned:
1. Assists clinicians in understanding the use of data for the improvement of practice.
2. Develops and maintains dashboards for ICM leadership and staff, uses pivot tables and graphs to report outcomes to leadership.
3. Maintains and updates specific departmental workflow tools as needed.
4. Provides ad hoc and routine data reports from the CM, UM and Denial dashboards, Premier, Veracity, Optum coding/abstracting system, healthcare applications or other sources. This includes testing data quality prior to submission, reviewing post-submission quality reports and correcting data issues as necessary.
5. Serves as a source of expertise for internal and external sources of data, its validity, methods for data access and information policy issues.
6. Tests, reviews, corrects, and submits monthly data to MHC corporate leadership for distribution to executive and subsidiary McLaren leadership team.
7. Assists in educating ICM team colleagues about complex clinical appeals, utilization review, including role, responsibilities tools, and methodologies.
8. Maintains current knowledge of hospital billing processes, applicable CMS rules and billing regulations related to Medicare, Medicaid, and commercial insurance. Participates in the resolution of retrospective billing issues and standardization processes within ICM.
9. Maintains confidentiality of all information obtained while participating in ICM data analysis activities.
10. Assists leadership in the collection and analysis of clinical productivity benchmarking and assures continuity between benchmarking and other reported patient discrepancies.
11. Provides orientation and training to new department employees related to documentation and data collection necessary for staff to perform.
12. Complies, analyzes, and evaluates quality and clinical data to identify patterns or trends, using statistical process and controls and various databases or software programs.
- Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies.
14. Performs other related duties as required and directed.
Qualifications:
Required
- Bachelor’s degree in healthcare, coding, billing, or related field
- Three years’ experience providing access to and developing data resources for studying clinical and health service processes
- Three years’ experience in coding/documentation and billing regulations related to third party payer denials, primarily RAC-related activities, and commercial appeals
Preferred:
- Experience in denials management, utilization management, coding or billing
- Certified Health Data Analyst (CHDA)
- RHIT/RHIA credentials
- Experience with databases, spreadsheet software and presentation software
Additional Information
- Schedule: Full-time
- Requisition ID: 25000382
- Daily Work Times: 8a-430pm
- Hours Per Pay Period: 80
- On Call: No
- Weekends: No
McLaren Health Care is an Equal Opportunity Employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sexual orientation, gender identification, age, sex, marital status, national origin, disability, genetic information, height or weight, protected veteran or other classification protected by law.
