Denials Management Manager Remote

AdventHealth Corporate

All the benefits and perks you need for you and your family:

• Benefits from Day One

• Career Development

• Whole Person Wellbeing Resources

• Mental Health Resources and Support

Our promise to you:

Joining AdventHealth is about being part of something bigger. It's about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.

Shift : Full-time, Monday-Friday

Job Location : Remote

The role you'll contribute:

The Denials Management Manager is responsible for the planning, managing and evaluation of denials management functional areas daily including but not limited to denials management, appeals, expediting billing and payments for insurance claims, customer service, performing outgoing calls and correspondence to patients and insurance companies for accurate billing, resolving claim adjudication issues and responding to audit requests. Responsible for the future growth and development of the Denial Management Team for Advent Health in accordance with the professional standards, procedures, and internal policies, as well as regulatory requirements. Accountable to meet and/or exceed financial and operational metrics established by AdventHealth Leadership and proactively work to minimize errors and claim denials. Accountable for running team reports, ensuring policies and procedures are consistently followed, including training, education and maintenance of quality assurance (QA) processes. Serve as a centralized resource for the integrity of billing and compliance issues.

Provides direction to professional and supervisory staff across AdventHealth regions and facilities. Participates in strategic planning for the enterprise revenue cycle. Participates in the identification of opportunities to improve processes and to act as a catalyst for realizing these improvements. Acts as a facilitator and generator of new ideas and a mediator on difficult issues. Serves as a liaison between team and other departments and agencies inside and outside AdventHealth. Performs duties in absence of senior leadership and will be called to represent leadership at meetings. This position is responsible for employee hiring, training, education, development of staffing plans, and employee engagement. Creates customer service driven teams and fosters collaboration with physician and administrative colleagues. This position may require occasional travel. Adheres to AdventHealth Compliance Plan and to all rules and regulations of all applicable local, state and federal agencies and accrediting bodies.

The value that you bring to the team:

• Responsible for providing direction for audits and denials management functions and providing the denials management supervisors with the necessary tools to ensure the teams operate effectively and minimize errors, rejections, and avoidable denials.

• Ensures that follow up and denial management activities are delivered in accordance with ADVENTHEALTH standards and appropriate policies, guidelines, training, and practices are in place for staff to achieve departmental and organizational goals.

• Responsible for the analyses of analytics to identify root causes and identify/implement process improvements to avoid repetition of errors that lead to claim denials/rejections.

• Collaborate with Revenue Cycle stakeholders and facilitate data sharing with the goal of maximizing claims reimbursement and mitigating financial losses.

• Responsible for monitoring/reviewing results as achieved by team members in meeting timeliness, productivity, and quality standards in relation to the needs of the department and organization.

• Accountable for the performance, measurement, monitoring, and reporting of functional areas aligned with established management targets/KPIs. Establishes annual departmental goals and provides direction regarding departmental standards set by the AdventHealth Leadership Team.

• Responsible for planning, problem resolution (inclusive of Human Resource issues), staffing, training, mentoring, maintaining procedures and resource allocation for areas of responsibility, to include approving staffing realignment and performance appraisals based on supervisors and director recommendations.

• Responsible for assuring timely, accurate and comprehensive documentation of all claim activities.

• Serves as a liaison between multiple Revenue Cycle Departments, including but not limited to Consumer Access, Patient Financial Services, Managed Care, Revenue Integrity and Care Management.

• Interviews applicants for open positions using Action Based Interview process. Processes paperwork for all new hires following departmental guidelines, and uses correct formula to quote hire in salaries, if necessary. Ensures 90 day on the job training program is successful. Provides succession planning and encouragement to team members in order promote positive career growth within AdventHealth.

• Maintains extensive knowledge of regulatory and billing guidelines, and working knowledge of revenue cycle processes while proactively researching new and changing regulations to ensure system operations are aligned with requirements.

• Responsible for the development and implementation of internal controls to ensure compliance with federal, state, and other legal regulations while providing service to AdventHealth departments, physicians, staff and external customers in a fiscally responsible manner.

• Implements new programs and procedures to improve services, operations and efficiency as well as responds to changes within the institution and changes in the external environment.

• Consistently demonstrates and encourages a commitment to quality, customer-centeredness, productivity and continuous improvement. Consistently, demonstrate comprehensive and thorough understanding of all elements of health care delivery, including strategy, business planning, employee and third-party agreements, operations and financial conditions.

• Supports Denials Management Directors and Executive Director with planning and execution of department initiatives.

• Participates in denials management committees and provides updates on denials trends, root cause analysis, issues and remediation plans. Oversees implementation of remediation plans and preventative strategies to reduce denials and maximize reimbursement.

Qualifications
The expertise and experiences you'll need to succeed :

• Bachelor's Degree (in Business, Healthcare or Health Services Administration, Health Information Management, Communications, Finance, Accounting, Public Administration, Human Resources, Management, or Marketing), OR Minimum of five years related work experience in a hospital-based revenue cycle department or related area (registration, finance, collections, customer service, medical office/physician, or contract management).

• Minimum of three years of hospital denial management experience in a large, integrated healthcare delivery system

• Minimum of three years in a supervisory/managerial position in a similar-sized healthcare organization.

Preferred Qualifications :

• Master's Degree (in Health Management, Business Administration, Finance, or other related area.)

• Understanding of PFS registration and billing processes

• CPAM, FHFMA, or CHFP

• Certified Revenue Cycle Representative (CRCR)

• Proficiency with medical billing and remittance forms and processes, including 835 and 837 files, and UB04 and CMS-1500 (HCFA) forms

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