Healthcare Denial Process Manager

2 days ago


Tuscaloosa, Alabama, United States DCH Health System Full time

Job Summary

We are seeking a skilled Healthcare Denial Process Manager to join our team at DCH Health System. As a key member of our organization, you will play a critical role in managing denials and optimizing revenue opportunities.

About the Role

The Healthcare Denial Process Manager will be responsible for leading and supervising denial staff, managing denial projects, and collaborating with clinical staff on the clinical appeal process. You will also be responsible for overseeing the clinical appeal process for outpatient denials, staying abreast of updates and changes to regulatory billing updates, and coordinating training and operations for the Denials Team.

Key Responsibilities

  • Lead and Supervise Denial Staff: Direct and manage denial staff to achieve optimal results in denial management.
  • Manage Denial Projects: Develop and implement effective strategies to minimize denials and optimize revenue opportunities.
  • Clinical Appeal Process: Collaborate with clinical staff to ensure proper documentation is provided to support appeals of unauthorized inpatient days or days denied for lack of documentation.
  • Outpatient Denials: Oversee the clinical appeal process for outpatient denials, including outpatient prior authorization denials, radiology denials, and HMO denials.
  • Regulatory Updates: Stay current with updates and changes to regulatory billing requirements and organizational compliance policies.
  • Training and Operations: Coordinate training and operations for the Denials Team to ensure they have the necessary skills and knowledge to succeed.

Requirements

  • Education: Bachelor's degree required; Master's degree preferred.
  • Experience: Two years of supervisory experience or project management experience required.
  • Skills: Strong analytical and problem-solving skills, excellent communication and leadership abilities, and proficiency in Microsoft Excel, PowerPoint, and other software applications.
  • Knowledge: Knowledge of CPT/ICD-10 coding and medical terminology, as well as Medicare, Medicaid, and Blue Cross regulatory requirements.

Salary

$65,000 - $80,000 per year, depending on experience.

Benefits

DCH Health System offers a comprehensive benefits package, including health insurance, retirement savings plan, paid time off, and continuing education opportunities.



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