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Clinical Denials Director
2 months ago
Job Summary:
The Director, Clinical & DRG Denials provides strategic leadership and administrative guidance to the Clinical Revenue Cycle department. This role is responsible for directing performance improvement initiatives, developing and maintaining operational policies, and ensuring regulatory compliance. The Director will work collaboratively with physicians, nursing staff, Quality, Finance, and others to develop and implement strategies that capitalize on facility and industry best practices to achieve targeted outcomes.
Key Responsibilities:
- Develops strategies and tactics to successfully execute, support, implement, and monitor the DRG and Utilization Management Clinical Denial teams Work Plan.
- Assists in the development and implementation of policies and procedures.
- Identifies, communicates, and holds staff accountable for performance expectations.
- Monitors/appraises job results/performance and promotes a positive, team-oriented work environment.
- Develops relationships and influences payer policies and procedures.
- Facilitates strong working relationships between HIM, Clinical Documentation, UR, Physician Advisor operations, PFS, Contracting, and hospital departments and leadership.
Requirements:
- BA or BS in a health-related field required.
- MHA or MBA preferred.
- 10 years of experience in a healthcare environment required.
- 8 years of experience with Insurance Carriers, Payer policy trends, and Revenue Cycle management concepts required.
- 5 years of experience in a large, complex acute care setting in a supervisory/administrative role required.
- 5 years of experience with Basic computer skills, including Microsoft Word, Microsoft Excel, and Microsoft Outlook required.
- 8 years of experience in a multi-hospital system and/or managed care required.
- 10 years of experience with Federal, state, and accreditation guidelines, financial principles, reimbursement methodologies, coverage issues, documentation, coding conventions, and insurance/managed care practices required.
Salary Range:
$95,503-$149,366 annually. Wage will be determined based on factors such as candidate's experience, qualifications, internal equity, and any applicable collective bargaining agreement.
