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Denials Operations Intern- St. Vincent Hospital

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R1 Revenue Cycle Management


R1 RCM Inc. is a leading provider of technology-enabled revenue cycle management services which transform and solve challenges across health systems, hospitals and physician practices. Headquartered in Chicago, R1 is a publicly-traded organization with employees throughout the US and international locations.Our mission is to be the one trusted partner to manage revenue, so providers and patients can focus on what matters most. Our priority is to always do what is best for our clients, patients and each other. With our proven and scalable operating model, we complement a healthcare organization's infrastructure, quickly driving sustainable improvements to net patient revenue and cash flows while reducing operating costs and enhancing the patient experience.The Denials Operations Intern will be responsible for partnering with client representatives and the R1 team to perform detailed reviews of facility-wide financial and operational metrics with the goal of identifying and capitalizing upon opportunities for process, cost, and patient satisfaction improvement. This person will:* Maintain a strong focus on identifying the root cause of denials while creating sustainable solutions to prevent future denials.* Utilize R1 technology, training, and process excellence initiatives across all aspects of revenue cycle.* Interpret data sets and create data analyses to drive desired results.* Respond to ad-hoc requests and develop solutions in a timely manner.* Coach all staff to improve workflow and operational performance.* Provide value-add feedback to R1 leadership on development of project plans.* Ensures the execution and compliance of the denials playbook.* Other activities as determined by the Site Lead.In this role, the successful candidate will collaborate with client representatives and the R1 team to identify, review, and monitor key indicators for potential process improvement opportunities.The successful candidate must have critical thinking skills and have demonstrated competency analyzing data and completing process improvement initiatives.Responsibilities:* Review concurrent, initial, and final denials for root cause and identify opportunity for upstream process improvement* Create in-process tracking and trending to allow for early identification of defects* Collaborate with hospital clinical departments, Case Management, Patient Access, Coding, Billing, Physician Advisors, Managed Care, etc. to implement practices to prevent future denials* Escalate wrongful denials to payer meetings for resolutionRequired Qualifications:* A Bachelor's degree and demonstrated academic achievement.* 2-5 Years professional experience demonstrating progressive responsibility.* Critical thinking skills - The ability to analyze, communicate, and creatively problem solve with an open mind.* Interpersonal Skills - The ability to establish oneself as a peer and trusted partner for our client counterparts.* Change Management - The ability to help counterparts through difficult transitions to a new process, workflow, or situation.* Motivation / Drive - Successful candidates will have a desire for continuous learning. Self-starting and going beyond what is asked to take on new challenges and create innovative solutions.* Tenacity /Grit - This role will require getting deep into details and performing very granular reviews and extensive process shadowing. While this work can be tedious, it is foundational to success.* Analytical Skills - Understanding of complex Excel and Access and/or simple SQL and Visual Basic are a plus. More important is mathematical / analytical aptitude and desire to invest the time to learn.* Permanent US work authorization.Desired Qualifications:* Direct experience in denials reduction initiatives, including familiarity with insurance portals* Professional experience with Utilization Management best practices.* Working knowledge of Utilization Review evidence-based criteria and care guidelines, including InterQual , MCG and the Two-Midnight Rule.Working in an evolving healthcare setting, we use our shared expertise to deliver innovative solutions. Our fast-growing team has opportunities to learn and grow through rewarding interactions, collaboration and the freedom to explore professional interests.Our associates are given valuable opportunities to contribute, to innovative and create meaningful work that makes an impact in the communities we serve around the world. We also offer a culture of excellence that drives customer success and improves patient care. We believe in giving back to the community and offer a competitive benefits package. To learn more, visit:
Associated topics: care physician, clinic, family, family practice physician, general practice, hospitalist, nocturnist, physician, physician md do, practitioner
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