PFS Contract Variance Anlst Sr, Denials Analysis

Hennepin Healthcare is an integrated system of care that includes HCMC, a nationally recognized Level I Adult Trauma Center and Level I Pediatric Trauma Center and acute care hospital, as well as a clinic system with primary care clinics located in Minneapolis and across Hennepin County. The comprehensive healthcare system includes a 473-bed academic medical center, a large outpatient Clinic & Specialty Center, and a network of clinics in the North Loop, Whittier, and East Lake Street neighborhoods of Minneapolis, and in the suburban communities of Brooklyn Park, Golden Valley, Richfield, and St. Anthony Village. Hennepin Healthcare has a large psychiatric program, home care, and operates a research institute, philanthropic foundation, and Hennepin EMS. The system is operated by Hennepin Healthcare System, Inc., a subsidiary corporation of Hennepin County.

Equal Employment Opportunities: We believe equity is essential for optimal health outcomes and are committed to achieve optimal health for all by actively eliminating barriers due to racism, poverty, gender identity, and other determinants of health. We are committed to equitable care and working in an environment that celebrates, promotes, and protects diversity, equity, inclusion, and belonging. We are committed to bringing in individuals with new cultural perspectives to assist in creating a more equitable healthcare organization.

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

You've made the right choice in considering Hennepin Healthcare for your employment. We offer a wealth of opportunities for individuals who want to make an impact in our patients' lives. We are dedicated to providing Equal Employment Opportunities to both current and prospective employees. We are driven to connect talented individuals with life-changing career opportunities, enabling you to provide exceptional care without exception. Thank you for considering Hennepin Healthcare as a future employer.

Please Note: Offers of employment from Hennepin Healthcare are conditional and contingent upon successful clearance of all background checks and pre-employment requirements.

• We offer a competitive pay rate based on your skills, licensure/certifications, education, experience related to this position, and internal equity.
• We provide an extensive benefits program that includes Medical; Dental; Vision; Life, Short and Long-term Term Disability Insurance; Retirement Funds; Paid Time Off; Tuition reimbursement; and license and Certification reimbursement (Available ONLY for benefit eligible positions).
• For a complete list of our benefits, please visit our career site on why you should work for us.