Responsible for all team members engaged in providing follow up and denials management activities, including significant expertise in managing revenue cycle workflows designed to optimize customer experience and maximize reimbursement.
In collaboration with the Executive Director, the Denials Management Director is responsible for providing direction to denials management functions and providing the denials management managers with the necessary tools to ensure the department operates effectively, resulting in accurate, timely resolution of denials and appeal submissions.
Responsible to achieve accounts receivable aging, recovery, and SLA targets established by department leadership
Responsible for the resolution of outstanding accounts receivables related to underpaid encounters or claims due to variances between actual payment and expected reimbursement as calculated by the Contract Management tools.
Works with Managed Care to identify and systematically resolve patterns of underpaid claims with managed care organizations, insurance companies, and governmental programs. Monitor, analyze and assess denial management trends and coordinate mitigation and denial prevention activities when opportunities for improvement are identified.
In collaboration with Prevention Analysts, devise new methods, procedures, and approaches to prevent denials across the organization and be able to introduce and gain support for these process improvements.
Contributes to the effective implementation of any required IT related solutions to perform the denial management workflow
Proactively work with corporate and regional leadership to ensure adoption of standard processes and industry leading best practices
Develop, assesses, and adapt clear and effective denial management process, policies and procedures, training, communications and awareness material to support the continuous process improvements of the team
Mobilize and motivate team members towards achievement of all departmental productivity and quality goals
Optimize and standardize current processes, develop solutions for performance shortfalls and monitor to ensure consistent adherence to policies and procedures.
Empower team leadership and staff to develop methods of process improvement, including planning, setting priorities, conducting systematic performance assessments, implementing improvements based on those assessments and maintaining achieved improvements.
What You Will Need:
Bachelor’s Degree in finance, accounting or other business field OR Minimum of eight years related work experience in a large integrated healthcare delivery system
Minimum of five years in a supervisory/managerial position in a similar-sized organization
Under the direction of the Executive Director of Denials Management, the Denials Management Director leads denials management functional areas responsible for denial and underpayment identification, classification, recovery, prevention, and reporting. This role is accountable to meet financial and operational metrics established by AH and Department leadership, efficiently maximizing financial recovery and minimizing denials and underpayments.
This leader directs managers across the enterprise-wide denials management team to assure the integrity and stability of the daily performance of denials and appeals related operations and delegates responsibility and authority to carry out effective action. This leader equips their team to maximize recovery efforts while maintaining efficiency and serves as the responsible point of contact for issues or questions related to denials or appeals for their team. Facilitates all necessary training to team leaders; oversees vendors and team members responsible for denial management process. As a crucial element of executing their responsibilities, this leader interacts with all levels of management and staff across facility revenue cycle, managed care, regional patient financial services centralized business office, AH corporate, and with outside entities such as payers, vendor partners, and government agencies.
At AdventHealth, Extending the Healing Ministry of Christ is our mission. It calls us to be His hands and feet in helping people feel whole. Our story is one of hope — one that strives to heal and restore the body, mind and spirit. Our more than 80,000 skilled and compassionate caregivers in hospitals, physician practices, outpatient clinics, urgent care centers, skilled nursing facilities, home health agencies and hospice centers are committed to providing individualized, wholistic care.