Utilization Management Analyst, 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 Utilization Management Analyst to join our Denials Analysis. This full-time role will primarily work remotely, but may need to come on-site when needed (Day).

Purpose of this position: The Utilization Management Analyst plays a critical role in reviewing, appealing, and preventing clinical denials related to medical necessity, level-of-care, and authorization issues. This position bridges clinical
and revenue cycle operations by evaluating payer denials, coordinating peer-to-peer reviews, and working
closely with physician advisors, case management, and revenue cycle teams. The UM Analyst helps
ensure regulatory compliance, timely appeals, and reduction of avoidable denials through proactive
collaboration and data-driven insight.

Current List of non-MN States where Hennepin Healthcare is an Eligible Employer: Alabama, Arizona, Arkansas, Colorado Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kentucky, Maryland, Massachusetts, Nevada, North Carolina, North Dakota, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, Wisconsin.

RESPONSIBILITIES:

• Create and keep-current a Payer Grid to track authorization rules, contacts, and changes supporting a denials prevention program
• Collaborate with UM staff to review for medical necessity and authorization-related denials to determine appeal potential based on clinical documentation, payer policies, and CMS criteria
• Collaborate with UM staff to draft and submit compelling clinical appeals, including summaries and supporting documentation in accordance with payer-specific requirements
• Coordinate peer-to-peer reviews and communicate with physicians, case management, and payers to ensure timely escalation and resolution
• Collaborate with Care Management, Clinical Documentation Improvement (CDI), and Revenue Integrity teams to identify and close documentation gaps
• Monitor and manage assigned work queues in Epic for UM-related denials, ensuring timely follow-up and resolution
• Evaluate denied inpatient claims for appropriate level-of-care assignment using InterQual, MCG, or similar criteria
• Participate in multidisciplinary denial review or task force meetings to identify trends and root causes
• Provide feedback and education to clinical and non-clinical staff to reduce preventable denials and improve documentation quality
• Support proactive denial prevention by reviewing high-risk accounts and participating in concurrent review processes
• Track appeal success rates and denial overturn metrics; report findings to leadership to inform strategy

QUALIFICATIONS:

Minimum Qualifications:

• Associate degree in Health Care related field, Health Information Management, or related field
• Minimum 3 years of experience in clinical care, utilization review, case management, or clinical denials/appeals

-OR-

• An approved equivalent combination of education and experience

Preferred Qualifications:

• Bachelor's degree
• Active RHIA, RHIT, CCS, or similar clinical/technical licensure
• Experience with payer guidelines, authorization workflows, and appeal writing

Knowledge/ Skills/ Abilities:

• Strong understanding of payer denial policies, CMS guidelines, and UM criteria (InterQual, MCG, etc.)
• Proficient in interpreting medical records, clinical terminology, and reimbursement methodologies
• Working knowledge of Epic
• Excellent written and verbal communication skills, with the ability to interface with physicians, nurses, and payer representatives
• Strong analytical skills and ability to identify trends and improvement opportunities

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.