Denial Prevention Process Improvement Specialist I

Site: Mass General Brigham Incorporated Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham. Job Summary As a member of the Denial Prevention Team, the Denial Prevention Process Improvement Specialist will drive continual improvement efforts to prevent insurance rejections and related write offs. Responsible for analyzing, designing, and implementing process improvement initiatives to enhance the quality of patient care, operational efficiency, and patient safety by identifying areas for improvement, streamlining processes, and promoting a culture of continuous improvement within the hospital. Essential Functions -Utilize knowledge of revenue cycle and hospital operations to interpret denial data, identify trends and translate findings into actionable prevention strategies. Analyze existing denial prevention healthcare processes, workflows, and procedures to identify inefficiencies, bottlenecks, and areas for improvement. -Develop and implement performance metrics and key performance indicators to measure process effectiveness and track improvement initiatives. -Lead or participate in quality improvement projects to optimize patient care, patient safety, and healthcare outcomes. -Gather and analyze data related to process performance, patient outcomes, and other quality-related indicators to inform improvement efforts. -Conduct root cause analysis to identify the underlying factors contributing to process issues or adverse events. -Collaborate with cross-functional teams to design and implement redesigned processes that are efficient, standardized, and aligned with best practices. -Facilitate change management efforts to ensure successful implementation of process improvements and promote staff buy-in. -Continuously monitor and evaluate the effectiveness of implemented improvements and make adjustments as needed. Qualifications Education • Bachelor's Degree in a related field of study required Experience • 1-2 years of process improvement/quality management experience preferred Knowledge, Skills and Abilities • Strong data analysis and statistical skills to interpret performance data and identify trends. • Familiarity with healthcare operations, patient care processes, and healthcare quality standards. • Excellent communication and interpersonal skills to collaborate with various stakeholders and present findings and recommendations. • Strong problem-solving and critical-thinking skills to identify process issues and implement effective solutions. • Proficiency in project management to lead and coordinate improvement projects from initiation to completion. • Skilled in Excel functions, formulas, and pivot tables. Additional Job Details (if applicable) Remote Type Remote Work Location 399 Revolution Drive Scheduled Weekly Hours 40 Employee Type Regular Work Shift Day (United States of America) Pay Range $62,400.00 - $90,750.40/Annual Grade 6 At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package. EEO Statement: Mass General Brigham Incorporated is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran's Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-282-7642. Mass General Brigham Competency Framework At Mass General Brigham, our competency framework defines what effective leadership "looks like" by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline. Apply tot his job