PFS Contract Variance Analyst Sr, Denials Analysis

Requirements

• Leads the Contract Variance Appeal process, overseeing intake, documentation, and strategic tracking of appeals submitted to third-party payers
• Manages and executes high-impact appeals, ensuring timely resolution through proactive coordination with internal stakeholders and payer representatives
• Conducts advanced research and analysis to support appeal documentation, staying abreast of payer policies, regulatory changes, and industry trends
• Serves as a liaison across departments, facilitating collaboration and ensuring comprehensive data collection for effective appeal resolution
• Leads the maintenance and optimization of the Contract Variance tracking system, ensuring data integrity and generating actionable reports for leadership
• Identifies and analyzes trends in contract variances and denials, providing insights to inform payer negotiations and operational improvements
• Develops and presents analytical reports and executive summaries to senior leadership, highlighting performance metrics and strategic recommendations
• Resolves complex appeal issues independently, contributing to cross-functional problem-solving initiatives
• Champions quality and process improvement efforts, leading initiatives to enhance efficiency, accuracy, and compliance within the appeals workflow
• Ensures strict adherence to HIPAA, organizational policies, and regulatory standards, embedding compliance into all operational activities
• Demonstrates expert-level professionalism and precision in all communications, documentation, and stakeholder interactions
• Leads system testing and documentation updates related to Contract Variance workflows, ensuring alignment with evolving business needs
• Designs and delivers training programs to build team capabilities and support ongoing professional development
• Provides strategic oversight of fatal denial assessments and Contract Variance documentation, ensuring consistency and accuracy across cases
• Maintains and enhances performance dashboards, ensuring data accuracy and delivering insights to drive decision-making
• Prepares high-level materials for leadership review, including meeting documentation, trend analysis, and strategic recommendations
• Fosters a collaborative, high-performance team culture, promoting accountability, innovation, and continuous improvement
• Performs duties as assigned, contributing to departmental goals and organizational success

Benefits

• Medical
• Dental
• Vision
• Life
• Short and Long-term Term Disability Insurance
• Retirement Funds
• Paid Time Off
• Tuition reimbursement
• License and Certification reimbursement