PeaceHealth is seeking a Denials Management Manager - Revenue Integrity for a Full Time, Day position.
Responsible for actively supporting the execution of strategic initiatives, process re-design, root cause analysis, metric and report development, creation of educational materials and special projects as it relates to denials management. This caregiver will develop, monitor and report defined denial metrics that support network and system wide initiatives, assist in the facilitation of the reduction of denial trends and revenue leakage, measure process effectiveness and productivity, and identify any need for updated policies and procedures. Serves as a liaison between revenue cycle, clinical departments, payers, and others to ensure effective communication and collaboration between all parties.
- Produces reports that provide denial details and patterns to drive root cause resolution and/or process improvement. Responsible for developing root cause resolutions/process improvement suggestions and coordinating efforts with the Revenue Cycle and TSP for implementation. Monitors the implementation process to validate improvement.
- Proactively works with cross-functional teams within PeaceHealth to develop procedures to reduce the number of denials received through reporting and education of denial trends. Partners with representatives and subject matter experts leveraging resources to cultivate standard work and process improvements across the organization. Develop plan to communicate, implement, drive and support operational enhancements. Maintains the internal issue log to track and monitor root cause issues and identified solutions to ensure resolution and reduction in denial trends.
- Facilitates meetings as they relate to denials management, education, and implementation of root cause corrections and/or workflow improvements. Facilitates coordination between and among revenue cycle departments and clinical departments to identify & mitigate denial trends. Manages the implementation and testing of denials-related technical updates/enhancements.
- Works with Payor Contracting Department to understand payor contract interpretation. Creates and maintains payor specific educational correspondence and distributes to Revenue Cycle. Continuously reviews applicable payor regulations, updates, and maintains current understanding. Researches federal and state mandates as they relate to billing and denials.
- Creates and delivers standard department and executive level reporting. Compiles, analyzes, and reports on data related to denials, revenue opportunities, and revenue leakage. Categorizes denials based on root cause findings and distributes reports and metrics to applicable management and associated teams on a monthly, quarterly, and yearly basis.
- Serves as a Revenue Cycle resource for billing and reimbursement issues.
- Performs ad hoc denial audits as requested and creates/runs denials related reports as requested.
- Supports PeaceHealth strategic objectives.
- Perform other duties as assigned.
- Bachelor’s degree in Accounting, Finance, Business Administration or related field required; or combination of education and experience that provides the caregiver with the requisite knowledge, skills and abilities to perform the job required.
- Minimum of five years of experience in a hospital finance or business office setting with increasing responsibility required particularly in healthcare billing, collections, payment processing, or denials management.
- Preferred knowledge related to Epic Billing Systems.
- Certified Revenue Cycle Representative (CRCR) certification preferred
- Certified Professional Coder (CPC) certification preferred
- Knowledge of billing requirements, general knowledge of medical terminologies, knowledge of payer contracts, appeal rights, and timely filing requirements of payers. Exercise understanding of claims adjudication rules. Ability to effectively collaborate with all departments and levels within the PeaceHealth system; Revenue Cycle, PFS, Central Scheduling, Care Management, Managers, Directors, CFO’s, etc.
- Experience in integrating financial, clinical, and coding processes to improve compliance and maximize reimbursement.
- Strong verbal, written and interpersonal communication skills with the ability to communicate effectively with individuals and groups at all levels within the PeaceHealth organization.
- Ability to take initiative by identifying problems, conceptualizing resolutions, and implementing change.
- A high degree of organizational skills and ability to follow through. Self-motivated with ability to work both independently and in a team setting.
- Excellent attention to detail with strong analytical and problem-solving skills. The impact of errors can be significant and a high level of attention to detail is crucial to ensure the expected outcome is accurate.
- Advanced computer skills to include Excel, Word, and knowledge of software for hospital contract and/or claims management.
- Ability to accurately run reports and analyze data; ability to navigate multiple software sites simultaneously.
- ability to work efficiently and responsibly in a collaborative environment with multiple work demands and short time frames.
- Strong analytical, critical thinking and problem-solving skills.
- Ability to make objective assessments..
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For full consideration of your skills and abilities, please attach a current resume with your application. EEO Affirmative Action Employer/Vets/Disabled in accordance with applicable local, state, or federal laws.