Denials Optimization Associate
Maine
- Healthcare
- Full-time
- denials management
- revenue cycle
- healthcare operations
The Denials Optimization Associate is responsible for improving healthcare claim denial processes by optimizing work delivery, monitoring vendor performance, and collaborating with internal and external stakeholders. Key duties include managing claims workflows, analyzing data to mitigate risks, and developing protocols to ensure efficient service delivery. The role also involves mentoring team members and supporting operational priorities to enhance revenue cycle management.
Join us as we work to create a thriving ecosystem that delivers accessible, high-quality, and sustainable healthcare for all.
Position Summary:
The Denials Optimization Associate will be responsible for driving service stability by enhancing work delivery structures, enhancing vendor performance, and removing barriers to service performance.
Essential Functions (Duties and Responsibilities):
45% Work Delivery Administration and Infrastructure Development
- Configure and implement CBO worklists for efficient claim movement
- Monitor inflow/ outflow patterns for risks to MSC and effective inventory management
- Analyze vendor forecast accuracy to inform changes in delivery patterns
- Develop delivery, monitoring, and action taking infrastructures and methodologies to ensure the accurate and timely completion of claim denials
- Create and inform disaster recovery protocols
- Weigh in on deviations/ risks to budget obtainment
- Optimize performance
30% Stakeholder Collaboration
- Collaborate with internal stakeholders to identify and remediate risks to the business
- Communicate and lead conversations with BPO/ vendors regarding delivery priorities and requirements
- Hold BPO/ vendor partners accountable for poor performance and provide coaching/ insight to prevent recurrence
15% Miscellaneous Projects
- Handle additional projects and tasks as assigned
- Provide flexibility to support emerging business needs and operational priorities
10% Knowledge Sharing and Mentorship
- Train and mentor new hires and colleagues on Denials Management best practices
- Develop educational materials and artifacts to document internal processes
- Foster a collaborative team environment that encourages continuous learning and improvement
Education & Experience Required:
- Bachelor’s Degree (or equivalent professional experience)
- 3-5 years of experience in denial management, revenue cycle, or related operational roles
- Denials and/or work delivery/ performance monitoring experience preferred
- Strong ability to work cross-functionally and engage stakeholders at various levels
- Demonstrated ability to lead projects independently and deliver impactful results
Knowledge & Skills:
- Proficiency in Microsoft Office Suite (Excel, PowerPoint, Word, Outlook)
- Command of pivot tables preferred
- Basic data analysis skills
- Strong communication and collaboration skills
- Familiarity with project management concepts preferred
- SQL experience a plus
Expected Compensation
$50,000 - $86,000The base salary range shown reflects the full range for this role from minimum to maximum. At athenahealth, base pay depends on multiple factors, including job-related experience, relevant knowledge and skills, how your qualifications compare to others in similar roles, and geographical market rates. Base pay is only one part of our competitive Total Rewards package - depending on role eligibility, we offer both short and long-term incentives by way of an annual discretionary bonus plan, variable compensation plan, and equity plans.
About athenahealth
Our vision: In an industry that becomes more complex by the day, we stand for simplicity. We offer IT solutions and expert services that eliminate the daily hurdles preventing healthcare providers from focusing entirely on their patients — powered by our vision to create a thriving ecosystem that delivers accessible, high-quality, and sustainable healthcare for all.
Our company culture: Our talented employees — or athenistas, as we call ourselves — spark the innovation and passion needed to accomplish our vision. We are a diverse group of dreamers and do-ers with unique knowledge, expertise, backgrounds, and perspectives. We unite as mission-driven problem-solvers with a deep desire to achieve our vision and make our time here count. Our award-winning culture is built around shared values of inclusiveness, accountability, and support.
Our DEI commitment: Our vision of accessible, high-quality, and sustainable healthcare for all requires addressing the inequities that stand in the way. That's one reason we prioritize diversity, equity, and inclusion in every aspect of our business, from attracting and sustaining a diverse workforce to maintaining an inclusive environment for athenistas, our partners, customers and the communities where we work and serve.
What we can do for you:
Along with health and financial benefits, athenistas enjoy perks specific to each location, including commuter support, employee assistance programs, tuition assistance, employee resource groups, and collaborative workspaces — some offices even welcome dogs.
We also encourage a better work-life balance for athenistas with our flexibility. While we know in-office collaboration is critical to our vision, we recognize that not all work needs to be done within an office environment, full-time. With consistent communication and digital collaboration tools, athenahealth enables employees to find a balance that feels fulfilling and productive for each individual situation.
In addition to our traditional benefits and perks, we sponsor events throughout the year, including book clubs, external speakers, and hackathons. We provide athenistas with a company culture based on learning, the support of an engaged team, and an inclusive environment where all employees are valued.
Learn more about our culture and benefits here: athenahealth.com/careers
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