Director, Denial Management

1 month ago

Baltimore, Maryland, United States MEDSTAR HEALTH Full time

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 and
reimbursement 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 and
system 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 and
interventions.Works with Acute Case Management teams focusing on operational improvements and team education to support denial
reduction.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 to
current governmental and state regulations.Manages business partner/vendor contracts, holding them accountable to contractual obligations and both industry and
organizational benchmarks.Supports the optimization of technology to enhance operational efficiency and improve reimbursement.

Minimum 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.

Why MedStar Health?
At MedStar Health, we understand that our ability to treat others well begins with how we treat each other. We work hard to foster an inclusive and positive environment where our associates feel valued, connected, and empowered. We live up to this promise through:

  • Strong emphasis on teamwork - our associates feel connected to each other and our mission as an organization. In return, our effective team environment generates positive patient outcomes and high associate satisfaction ratings that exceed the national benchmark.
  • Strategic focus on equity, inclusion, & diversity - we are committed to equity for all people and communities. We continue to build a diverse and inclusive workplace where people feel a sense of belonging and the ability to contribute to equitable care delivery and improved community health outcomes at all levels of the organization.
  • Comprehensive total rewards package - including competitive pay, generous paid time off, great health and wellness benefits, retirement savings, education assistance, and so much more.
  • More career opportunities closer to home - as the largest healthcare provider in the Baltimore-Washington, D.C. region, there are countless opportunities to grow your career and fulfill your aspirations.

This position has a hiring range of $111,
$201,427.20

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