PFS Contract Variance Analyst Sr, Denials Analysis

SUMMARY

We are currently seeking a PFS Contract Variance Analyst Senior to join our Denials Analysis team. This full-time role will work remotly (Days, M- F).

Purpose of this position: The Contract Variance Analyst Senior is responsible for leading the end-to-end appeals process related to contract variances and fatal denials. This role serves as a subject matter expert, managing complex appeal cases, analyzing trends, and driving resolution strategies in collaboration with internal departments and external payers. The analyst oversees data integrity within tracking systems, prepares executive-level reports, and contributes to strategic initiatives aimed at improving revenue cycle performance. This position also supports system enhancements and ensures compliance with regulatory standards and organizational policies.

RESPONSIBILITIES

• 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

QUALIFICATIONS:

Minimum Qualifications:

• Bachelor’s degree in Business, Finance, Health Care Administration, or related field
• A minimum of three (3) years’ experience in healthcare contract variance analysis, including an in-depth knowledge of healthcare claims processing
  -OR-
• An approved equivalent combination of education and experience

Knowledge/ Skills/ Abilities:

• Excellent problem solving skills
• Knowledge of EPIC claims processing systems and electronic health records
• Must have skills in data analysis and associated tools
• Proficiency with Microsoft Office
• Proficient with database reports (Clarity, EPIC workbench, etc)

License/Certifications:

Certification in one of the following:

• EPIC Resolute Hospital Billing and Professional Billing Insurance Claims Follow-Up - within 12 months of hire
  -or-
• Resolute Hospital Billing Expected Reimbursement Contracts Administration - within 12 months of hire