Director of Medical Policy

4 weeks ago

Baltimore MD, United States MEDSTAR HEALTH Full time

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.
Collaborates with VP, Clinical Resource Management and other leaders to identify denial mitigation opportunities and reimbursement improvement processes.
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.
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.


Bachelor's degree in Nursing required

5-7 years 5-7 years of Revenue Cycle experience including appeals and financial clearance required and
~ 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.
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.
MedStar Health is dedicated to providing the highest quality care for people in Maryland and the Washington, D.Our team of 32,000 includes physicians, nurses, residents, fellows, and many other clinical and non-clinical associates working in a variety of settings across our health system, including 10 hospitals and more than 300 community-based locations, the largest home health provider in the region, and highly respected institutes dedicated to research and innovation. As the medical education and clinical partner of Georgetown University for more than 20 years, MedStar Health is dedicated not only to teaching the next generation of doctors, but also to the continuing education, professional development, and personal fulfillment of our whole team. Together, we use the best of our minds and the best of our hearts to serve our patients, those who care for them, and our communities. We hire people to work in different locations, and we comply with the federal, state and local laws governing each of those locations. MedStar Health makes all decisions regarding employment, including for example, hiring, transfer, promotion, compensation, benefit eligibility, discipline, and discharge without regard to any protected status, including race, color, creed, religion, national origin, citizenship status, sex, age, disability, veteran status, marital status, sexual orientation, gender identity or expression, political affiliations, or any other characteristic protected by federal, state or local EO laws. If you receive an offer of employment, it is MedStar Health's policy to hire its employees on an at-will basis, which means you or MedStar Health may terminate this relationship at any time, for any reason.

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