Senior Clinical Denials Management Analyst - On Site

Beloit Health System is looking to add a Senior Clinical Denials Management Analyst to our Revenue Cycle Team!

• Shift: 1st

• Schedule: 6a - 6p (8-hours shifts within this window)

• Hours per week: 40

• Benefits Status: Eligible

• Department: Beloit Clinic Insurance/Billing

The Senior Clinical Denials Management Analyst leads advanced analysis, resolution, and prevention of healthcare claim denials to maximize reimbursement and improve revenue cycle performance. This role serves as a subject matter expert, driving denial prevention strategies, mentoring team members, and partnering with senior leadership, clinical, coding, billing, compliance, and contracting teams to reduce denial rates and financial risk.

• Lead complex denial investigations and high-dollar, high-risk appeals across all payer types
• Perform advanced root cause analysis to identify systemic issues impacting claim denials and underpayments
• Develop, monitor, and present denial metrics, trends, and executive-level reports
• Design and implement denial prevention strategies and corrective action plans
• Serve as a subject matter expert on payer policies, reimbursement methodologies, and regulatory requirements
• Collaborate with senior leadership, clinical, coding, CDI, contracting, billing, and registration teams to improve documentation and coding accuracy
• Oversee appeal strategy development, including medical necessity, authorization, and contractual disputes
• Monitor payer behavior, contract compliance, and denial patterns to identify escalation opportunities
• Support payer negotiations by providing denial data and financial impact analysis
• Mentor and provide guidance to coding, registration, and billing denial specialists
• Participate in internal and external audits and ensure adherence to compliance standards
• May require participation in payer meetings and leadership presentations

Job Requirements

• Bachelor's degree in healthcare administration, Finance, Business, or related field (or equivalent experience)
• 5+ years of progressive experience in healthcare revenue cycle, denials management, or reimbursement analysis
• Professional certification such as CRCR, CPC, CCS, or CHFP 
• Advanced knowledge of medical billing, coding (ICD-10, CPT, HCPCS), and payer reimbursement rules
• Strong experience with denial management systems, EHRs, and payer portals
• Advanced proficiency in Microsoft Excel and data analysis tools
• Proven ability to interpret complex data and translate it into actionable strategy
• Experience in hospital or multi-specialty health system environments
• Strategic and analytical thinking as work requires analytical skills to collect information from diverse sources, apply professional principles in performing various analyses, and summarize information and data in order to solve problems
• Leadership and mentorship
• Strong presentation and stakeholder communication skills, with ability to create reports from data available in various systems to satisfy the needs of senior management
• Ability to influence cross-functional teams
• Detail-oriented with a high level of accountability
• Familiarity with payer contract modeling and reimbursement analytics
• Good working knowledge of data management software applications
• Thorough knowledge and understanding of hospital financial operations, including the revenue cycle/reimbursement process
• Proficiency with Microsoft Excel
• Ability to work effectively in a team environment
• Strong investigative, analytical, organizational, and critical thinking skills
• Excellent written and verbal communication skills
• Ability to function effectively and meet deadlines
• Excellent negotiation and interpersonal communication skills
• Ability to prioritize multiple demands and work independently with minimal supervision
• Dependable in attendance, production and quality of work

BEHAVIOR AND ATTITUDE

The mission of Beloit Memorial Hospital requires the employee to perform in a manner which ensures delivery of the highest quality of medical services at an economic value and at the highest level of patient satisfaction. Respect and consideration given to the dignity of each patient, deserter, and fellow employee is a requisite of success job performance.

The above statements are intended to describe the essential functions and related requirements of persons assigned to this job. They are not intended as an exhaustive list of all job duties, responsibilities and requirements.