Denial Prevention Manager

3 weeks ago

Scottsdale, Arizona, United States CND Life Sciences Full time
Job Title: Denial Prevention Manager

CND Life Sciences is seeking a highly skilled Denial Prevention Manager to join our team. As a key member of our revenue cycle operations, you will be responsible for leading a team of denial prevention specialists to streamline and optimize the denial management process.

Key Responsibilities:
  • Develop and implement strategies to prevent claim denials at the source, focusing on areas like referral, pre-authorization, eligibility, and coding accuracy.
  • Manage and audit medical coding practices for accuracy and compliance with ICD-10-CM, AHA Coding Clinic, AMA CPT, and Lifepoint HSC guidelines.
  • Research and analyze payer denials across various revenue cycle stages.
  • Compose clear and compelling appeals based on medical record reviews and relevant Medicare, Medicaid, third-party, and CND guidelines, maximizing timely reimbursement recovery.
  • Provide expert guidance on complex coding issues and support the Billing staff with resolving coding-related queries.
  • Conduct regular audits of coding practices to identify and correct discrepancies, and implement corrective action plans as needed.
  • Collaborate with Billing, Clinical Services, Market Access, and Patient Access to optimize denial prevention strategies and enhance overall revenue cycle efficiency.
  • Identify denial trends and proactively educate staff on best practices to minimize future denials.
  • Manage outstanding AR related to denials.
  • Manage denial-related outstanding accounts receivable (AR) to ensure timely and accurate claim resolution.
  • Process and track correspondences and medical record requests following department workflow procedures to ensure timely and accurate responses.
  • Submit retro-authorizations in accordance with payor requirements in response to authorization denials.
  • Complete special projects as assigned.
Requirements:
  • Minimum of 5 years of experience in medical billing and denial management, with at least 3 years in a supervisory or management role preferably in a diagnostic laboratory setting.
  • Demonstrated knowledge of all insurance companies, HMOs, PPOs, Medicare, and other third-party payers.
  • Experience with Salesforce, Waystar, Trizetto, and Quadax is a plus.
  • In-depth knowledge of ICD-10, CPT, HCPCS coding systems and medical terminology.
  • Strong understanding of healthcare regulations, including HIPAA, CMS, and OIG guidelines.
  • Knowledge of business processes, accounting principles, billing practices, medical terms, billing software, and electronic health records (EHR) Systems.
  • Detail-oriented with excellent time management and multitasking skills.
  • Knowledge of Medicare, Medicaid, and commercial insurance.
  • Must have a good working knowledge of explanation of benefits (EOBs) and comprehensive understanding of remittance and remark codes.
  • Requires a high level of problem-solving and analytics skills.
  • Effective communication and interpersonal skills.
  • Strong skills with Microsoft Office, with a focus on Excel and Word.
  • Strong computer-based skills, specifically with Salesforce, Medisoft, Quadax, and Microsoft programs.
Education, Certifications, and Licensures:
  • Bachelor's degree in healthcare administration, business, finance, or related field; master's degree preferred.
  • Certified Coding Specialist (CCS), Certified Professional Coder (CPC), or equivalent certification required.
Special Training:
  • Salesforce, Quadax, TriZetto, Waystar.
Other:
  • This is a full-time remote opportunity for the MST time zone.
  • May require quarterly meetings in Scottsdale, AZ headquarters or regional office in Atlanta.

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