Sr. Denials Prevention Analyst

• Perform revenue cycle denial analytics to trend issues, identify root causes, and prioritize denial prevention opportunities.
• Conduct targeted account sampling and case reviews to validate findings and help define corrective actions.
• Prepare concise analytics summaries, denial prevention related PowerPoints and reports, and leadership readouts of workgroup findings.
• Lead and facilitate cross-functional discussions; connect interdependent topics across workgroups to align solutions.
• Build and maintain action plans with clear owners, timelines, and success metrics; document minutes, key takeaways, and next steps; distribute follow-up communications, reports, and analytics to attendees.
• Monitor denial prevention KPIs, initiative progress, and associated revenue impact; explain fluctuations and escalate barriers.
• Lead cross-functional root cause analysis with Patient Access, Patient Financial Clearance, UM/CM, CDI, HIM/Coding, Clinical Operations, and PFS to identify workflow, system, policy, and education changes needed to prevent denials and monitor progress on implementation of remediation strategies.
• Help develop and implement denial prevention strategies, workflows, and playbooks and monitor their effectiveness through regular KPI reporting.
• Monitor payer policy changes, national guidelines, and CMS/Medicare/Medicaid updates to ensure compliance and timely adjustment of practices.
• Maintain denial dashboards, action plans, and performance reports for leadership review.
• Prepare denial reports and summary findings of analysis for department leadership; maintain clear documentation of analyses and outcomes; escalate systemic risks and barriers as appropriate.

Education Qualifications

• High school diploma (or GED equivalent). Required
• Bachelor’s degree in a work-related field/discipline from an accredited college or university. Preferred

Experience Qualifications

• Five (5) years of progressively responsible and directly related work experience, with a preference for denial prevention, denial management, prior authorization, or revenue cycle specific experience.
• Two (2) years’ experience in denial prevention, denial recovery, prior auth, registration, coding, or denial management related role within a healthcare setting.
• 1-2 years of statistical analysis experience.

Required Knowledge, Skills and Abilities

• Domain experience across 2+ of the following areas: PAS, PFC, HIMS, Revenue Integrity, Coding, Professional Billing and Follow-up, Hospital Billing and Follow-up, Denial Prevention, Denial Management/Recovery, or Payment Compliance.
• Working knowledge of government and non-government payer requirements, reimbursement rules, laws, and regulations that govern billing/collection activities
• Working knowledge of Epic Hospital and/or Professional Billing; strong proficiency in Epic reporting, especially Slicer/Dicer, and the ability to translate data into actionable insights
• Ability to analyze and develop solutions to complex problems, including independently identifying problems through data analysis
• Ability to analyze information, reach valid conclusions and make sound recommendations
• Ability to manage, organize, prioritize, multi-task and adapt to changing priorities
• Working knowledge of medical terminology, CPT-4, ICD-9/ICD-10, HCPCS, and modifiers, and how these items drive reimbursement
• Analytical and problem-solving skills, with good judgment, attention to detail, and thorough follow-through
• Excellent verbal and written communication skills; ability to present complex data clearly to stakeholders
• Ability to communicate effectively in written and verbal formats including summarizing data, presenting results to senior leadership
• Ability to establish and maintain effective working relationships
• Knowledge of Microsoft Office software, including strong knowledge of Excel including but not limited to proficient with functions such as VLOOKUP, IF, IS, and macro commands for automation.
• Advanced reporting capabilities such as tableau, Power BI, SQL, etc. preferred.

Licenses and Certifications

• CPC - Certified Professional Coder required. or
• CRCR - Certified Revenue Cycle Representative required

These principles apply to ALL employees

SHC Commitment to Providing an Exceptional Patient & Family Experience

Stanford Health Care sets a high standard for delivering value and an exceptional experience for our patients and families. Candidates for employment and existing employees must adopt and execute C-I-CARE standards for all of patients, families and towards each other. C-I-CARE is the foundation of Stanford’s patient-experience and represents a framework for patient-centered interactions. Simply put, we do what it takes to enable and empower patients and families to focus on health, healing and recovery.

You will do this by executing against our three experience pillars, from the patient and family’s perspective:

• Know Me: Anticipate my needs and status to deliver effective care
• Show Me the Way: Guide and prompt my actions to arrive at better outcomes and better health
• Coordinate for Me: Own the complexity of my care through coordination

Equal Opportunity Employer Stanford Health Care (SHC) strongly values diversity and is committed to equal opportunity and non-discrimination inall ofits policies and practices, including the area of employment. Accordingly, SHC does not discriminate against any person on the basis of race, color, sex, sexual orientation or gender identity and/or expression, religion, age, national or ethnic origin, political beliefs, marital status, medical condition, genetic information, veteran status, or disability, or the perception of any of the above. People of all genders, members of all racial and ethnic groups, people with disabilities, and veterans are encouraged to apply. Qualified applicants with criminal convictions will be considered after an individualized assessment of the conviction and the job requirements.