Denver Health

Manager

• Manages the day to day operations that contributes to the capture, resolution, and collection of revenue
• Responsible for managing the day to day activities of the organization as they relate to revenue cycle functions which include; billing, insurance follow up, denial management, collections, cash posting, customer service, charge entry/corrections, supervision of vendors, and accounts receivables
• Works with the Director of Hospital and Physician Business Services on revenue cycle performance to meet strategic goals and provide analytical analysis
• Develops strategic plans and programs for the revenue cycle unit and ensures that goals and objectives of the unit are properly defined and clearly established
• Monitors timeliness and effectiveness of department activities, ensuring that outstanding insurance accounts receivables, patient accounts and bad debt are on target to meet monthly/yearly Key Performance Indicators
• Delineates, defines, and streamlines its various functional activities, thereby ensure its effectiveness in maximizing the utilization of both asset and people resources
• Oversees personnel by selecting talented, competent, conscientious supervisors and other employees
• Development of supervisors and other department personnel
• Ensures that prospective employee standards are aligned with Denver Health's core values
• Coordinates communication between patient access, medical records, UM, coding, EHS and other departments as necessary

Revenue Cycle Manager

Research Analyst

• Conducts subject-related activities, such as screening and consenting for recruitment, conducting chart review, collecting samples, patient navigation and scheduling, performing subject interviews, facilitating focus groups and tracking outcomes.
• Maintains clear, concise, and organized records.
• Exercises confidentiality regarding patient and other sensitive information.
• Ensures eligibility while treating participants with courtesy, dignity, empathy, and respect.
• Acts as primary point of contact for study participants.
• Assists with data management activities, including collection and entry, and assessment for accuracy, integrity, and intervention fidelity.
• Assists in database management, analysis and reporting, and disseminating results.
• Performs literature reviews, which may include literature searches, organizing results and summarizing findings.
• Assists with preparation and maintenance of all regulatory documentation.
• Builds and maintains strong relationships with research subjects, teams, collaborators, and colleagues.
• Adheres to all protocol, policy, and regulatory requirements required to conduct human subjects research, including training requirements for COMIRB and CITI.
• Remains aware of ways to improve team processes and brings them to leadership’s attention, aligning with DHHA’s Lean management principles.

Research Associate

Medical Billing and Coding

• Review medical record documentation to abstract and assign diagnoses, procedures, and modifiers for statistical classification and reimbursement purposes.
• Perform various coding assignments under the direction of Coding Management.
• Provide feedback regarding documentation and coding issues.
• Utilize software applications and coding references to perform coding related tasks.
• Assist with training.

Coder II

Medical writer

• Under general supervision performs concurrent and retrospective reviews as requested by the Clinical Documentation Integrity Manager or Director
• Responsible for selected assignments based on internal or external department requests
• Responsible for educating providers regarding documentation specificity, accuracy, compliance and are permitted to query physicians as deemed necessary
• Collaborates with Coding, Health Information Management (HIM), Patient Safety and Quality, Enterprise Compliance Services and other departments to promote the common goal of obtaining accurate documentation in the patient's record
• Must participate in continuous education on ICD-10, clinical medicine, Center of Medicare and Medicaid (CMS) and other billing carriers, as well as coding guidelines and policies
• Concurrent and/or retrospective review of designated inpatient, outpatient, and ambulatory patient records to assess for accuracy, specificity, and compliance of provider documentation
• Tracking audits performed and audit results obtained in order to provide meaningful data to key stakeholders
• Educating providers regarding documentation accuracy, specificity, and compliance with rules and regulations
• Providing pertinent feedback to providers on audit results as necessary
• Working collaboratively with Coding, Health Information Management (HIM), Patient Safety and Quality, Enterprise Compliance Services, and other departments to promote the common goal of obtaining accurate documentation in the patient record

RN Specialist, Clinical Documentation

Data Analyst

• Under minimal supervision, participates in the systems development life cycle for new development, enhancements and maintenance projects in multiple Data Warehouses
• Works closely with business leaders, end users and other technical resources to design and implement data and analytic solutions to enhance the business decision making process.
• Designs, develops and deploy ETL and data visualization software needed to prepare and deliver information in support a variety of business needs.
• Develop and support end to end Data Warehouse, Business Intelligence and Advanced Analytics solutions for analytics and management teams (25%)
• Responsible for designing, building, and supporting the components of data warehouse, such as ETL processes, databases, analytic marts and analytics environments, and other critical data pipelines (20%)
• Collaborates with the business analyst, user community, and other technical resources to thoroughly document requirements and detailed technical designs for software solutions based on functional requirements from the different business users (15%)
• Studies and understands the company’s business processes and applications, including their effect on data and analytics, and applies the knowledge gained in designing solutions to meet analytics needs (10%)
• Designs relational, dimensional and analytical models in accordance with best practices (10%)
• Perform code reviews, data validation, and system testing for data warehouse changes while establishing system documentation and ensuring it is continually sustained (10%)
• Interact closely with members of both IT and the business (10%)

Senior Analyst, Data Analysis, Science

Operations

• Provide day-to-day operational oversight of laboratory services across multiple clinical locations to ensure efficient workflows, high-quality service, and compliance with organizational standards.
• Supervise, coach, and support laboratory staff through regular one-on-one meetings, performance management, professional development, and annual evaluations.
• Address employee relations issues in collaboration with Human Resources.
• Monitor and manage financial performance across multiple administrative units, including budget preparation, expense monitoring, variance investigation, and productivity analysis to support responsible resource utilization.
• Support strategic growth initiatives by coordinating operational planning for new laboratory sites, clinic expansions, and service line development.
• Ensure ongoing readiness for regulatory and accreditation requirements, including Joint Commission standards, policy management, and coordination of survey preparation activities.
• Develop, analyze, and present operational metrics including productivity, volume trends, turnover, and other performance indicators to support leadership decision-making and continuous improvement.

Outpatient Operations Manager, Laboratory Services

• Reviews medical record documentation to abstract and assign diagnoses, procedures, and modifiers for statistical classification and reimbursement purposes.
• Provides feedback regarding documentation and coding issues.
• Utilizes software applications and coding references, including electronic, to perform coding related tasks.
• Maintains an understanding of and ensures compliance with, all applicable Official Coding Guidelines.
• Participates in coder and provider education including documentation improvement efforts for providers.
• Interacts with provider, nursing staff and departments as assigned.
• Assists in the training and quality assurance of all coding levels.
• Completes any required coding training or other assigned coding instruction.
• Participates in departmental coding and educational meetings and roundtables.
• Manages resources in a conservative, responsible and cost-effective manner.
• Ensures confidentiality of patient information by creating and maintaining a secure and trusting environment by not sharing information learned on the job, except when necessary in the performance of the job responsibilities.
• Works as a member of a coding team for the successful benefit of the department.

Coder IV

Analyst

• Assists the Commercial Products team with the maintenance and administration of the Denver Health Medical Plan, Inc. (DHMP) Exchange
• Ensures compliance with all State and Federal-level regulatory requirements requiring strong attention to detail
• Creates analyses and reports, assisting with project and implementation plans
• Develops marketing materials and provides input on policies and procedures for departmental activities
• Reviews all State and Federal regulations and policy changes
• Supports member experience through attending events and partnering with the Marketing team
• Works independently with the Commercial Products team and other Managed Care Departments
• Researches and resolves member and provider escalations
• Assists in setting strategic direction of projects, developing project plans, analytic support services and applicable technical/subject matter expertise to achieve organizational goals

Commercial Products Analyst I

Business Operations

• Managing health plan operations and regulatory compliance with emphasis on grievances and appeals.
• Overseeing review, investigation, documentation, processing, negotiating and resolving disputed medical insurance claims per federal and state regulatory requirements.
• Facilitating and participating in internal monitoring for compliance and regulatory audits.
• Providing oversight for administrative functions and management of the department, including personnel and financial management.
• Analyzing and evaluating service for quality improvement including productivity, strategic planning, budget management, and development of performance standards.
• Supervising staff training and managing productivity to ensure effective and balanced case workload.
• Building and managing effective partnerships that engage stakeholders in understanding the issues, identifying opportunities and assisting with resolution.
• Ensuring that department's milestones/goals are met and adhering to approved budgets.

Manager, Health Plan Business Operations – Grievances and Appeals

Director

• Provide strategic and operational leadership for all utilization management functions across the organization.
• Ensure clinically appropriate, cost-effective, and regulatory-compliant medical necessity determinations while supporting high-quality member outcomes and provider collaboration.
• Partner closely with Operations, Network Management, Quality, Compliance, and Finance to align utilization management strategy with organizational goals.
• Oversee multiple teams performing utilization management functions.
• Develop, implement, and evaluate formal educational activities and follow up on issues identified through educational activities.
• Ensure DHMP can provide documentation of compliance with contractual and regulatory requirements prior to audit.

Senior Director, Health Plan Utilization Management

• Owns overall HEDIS and CMS Core Measures clinical strategy and reporting intent across product lines
• Interprets NCQA HEDIS specifications, CMS Core Measures specifications, FAQs, and technical guidance
• Determines measure inclusion/exclusion, hybrid vs. administrative approach, and reporting decisions
• Provides clinical judgment and escalation support for complex or ambiguous scenarios
• Monitors NCQA HEDIS updates, CMS Core Measures updates, technical bulletins, FAQs, and measure changes
• Assesses the impact of upcoming HEDIS and CMS Core Measure changes on organization programs, data sources, and workflows
• Partners with IS (Information Systems) to identify and ensure changes are made outside of production season
• Partners with the MRR Manager on MRR strategy, reconciliation, and quality oversight
• Owns clinical QA/UAT for new or modified measures and other related data sources
• Owns business and clinical content of the HEDIS and CMS Core Measures Roadmap
• Works closely with IS, Product Line Managers, Population Health/QI, MRR, and vendors