About the Job General Summary of Position The Director Denial Management & Prevention is responsible for directing and administering the programs and activities of a denial prevention and recovery operations. In partnership with the VP Clinical Resource Management the Director will lead planning and execution of strategic initiatives around technical and clinical/medical necessity denials and appeals across system hospitals.
Primary Duties and Responsibilities Collaborates with VP Clinical Resource Management and other leaders to identify denial mitigation opportunities andreimbursement improvement processes. Oversees and directs appeals for the system to include oversight of any appeal vendors. Partners with system leaders to create implement and sustain improvements that contribute to the organization's goals.
Provides strategic direction and clinical oversight for hospital denials and appeal operations and outcomes. Works with organization leaders to develop performance goals and objectives based on industry best practices andsystem benchmarks. Develops and maintains analytics and dashboards to standardize entity denial summaries.
Supports system denial mitigation projects and serves as a consultant for individual entities regarding denial trends andinterventions. Works with Acute Case Management teams focusing on operational improvements and team education to support denialreduction. Collaborates with the Managed Care team to summarize and address payer opportunities.
Works with Corporate Compliance and Rates and Reimbursement team to ensure operations and policies conform tocurrent governmental and state regulations. Manages business partner/vendor contracts holding them accountable to contractual obligations and both industry andorganizational benchmarks. Supports the optimization of technology to enhance operational efficiency and improve reimbursement.
Minimal Qualifications Education Bachelor's degree in Nursing required Experience 5-7 years 5-7 years of Revenue Cycle experience including appeals and financial clearance required and Leadership experience in the healthcare industry with emphasis on revenue cycle preferred Licenses and Certifications RN - Registered Nurse - State Licensure and/or Compact State Licensure required Knowledge Skills and Abilities Team builder with excellent interpersonal skills Strong analytical and problem-solving skills with high level of accuracy and attention to detail.
Strong verbal and written communication skills including presentation skills with ability to effectively interact with all levels of management internal departments and external agencies. Computer skills are required to be efficient in managing data (Word PowerPoint Excel and email programs). Advance Microsoft Excel skills.
This position has a hiring range of USD $114,004.00 - USD $219,960.00 /Yr.