Vacancy expired!
Job Description
Summary : The Director of Denials and Appeals is primarily responsible for the day to day successful operation of the Denials and Appeals department.
Essential Duties and Responsibilities : include the following. Other duties may be assigned.
1. Provides leadership to implement departmental strategy and operations initiatives in order to achieve departmental KPI’s.
2. Develops, implements, and effectively manages policies, processes, and procedures for the Denials department that result in maintaining accounts receivable days outstanding at or below goal levels.
Provides education and policy updates for associates, facility medical staff, and insurance companies on policy or procedures.
Establishes and conducts performance r reporting for revenue activities of facilities. Works collaboratively with CFO's, hospital staff, and department heads to develop and maintain a culture of high performance and accountability across organizational boundaries
3. Provides revenue management reports to facilities and the executive team. Also, provides periodic status reports and ensures timely identification and reporting of potential risks to cash flow and compliance by alerting executive management and facility leaders of such concerns in the areas of accountability.
4. Directs the staff and operations of the Denials Department. Ensures optimal performance through effective employee selection, training and development, and performance management.
Holds staff accountable for achieving plans and performance targets. Works with staff to identify and resolve the most complex issues and problems impacting the ambulatory billing office.
Supports development and continued professional growth to meet SSC and individual KPI’s for long-term success. Demonstrates an expectation for continuous quality improvement utilizing processes that include consideration of all stakeholders
Qualifications : To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.
The requirements listed below are representative of the knowledge, skill, and / or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Knowledge / Abilities :
To perform this job successfully, an individual should have intermediate level knowledge of Microsoft Office Tools
as well as the hospital patient accounting systems.
Knowledge and use of Ontario Artiva, Hyland OnBase, HMS, Meditech, McKesson Star and Siemens Patient Accounting Systems are a plus
Effectively utilize Microsoft Office tools (Excel, Word, Access and PowerPoint)
Reasoning Ability : Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.
Computer Skills :
To perform this job successfully, an individual should have knowledge of Word Processing software; Spreadsheet software and Database software.
Certificates and Licenses : RN -preferred
Supervisory Responsibilities : Up to 5 direct reports with multiple indirect reports
Education / Experience :
Bachelors’ degree in a related field required. Masters’ degree in a related field preferred. 7-10 years experience with revenue cycle in a multi-hospital system required.
Physical Demands :
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Vacancy expired!