Supervisor, Denials Management

3 days ago

Greenville, North Carolina, United States Vidant Health Full time
Job Title: Supervisor, Denials Management

About the Role:

The Supervisor, Denials Management will be responsible for analyzing, tracking, measuring, preventing, and managing denials in collaboration with all areas of revenue cycle management. This role will work closely with the Manager/Director to provide staff oversight and assistance, ensuring timely and thorough appeal of all non-clinical denials and accurate and compliant resolution of all government-mandated audits.

Key Responsibilities:
  • Monitor reports and workloads to ensure timely denials resolution.
  • Develop and monitor goals for the denials team.
  • Provide guidance and oversight to the denials team to ensure steady reduction of preventable denials and account receivable days.
  • Contribute to the steady reduction of denials by addressing complex denials timely and identifying root causes and process improvements to prevent future denials.
  • Act as a liaison to various departments to streamline processes.
  • Assess processes, identify gaps, and implement efficient workflows.
  • Prepare and analyze monthly variance reports to present to Revenue Cycle Leadership, identifying trends by payer of payment variances.
  • Identify payment errors and work with payors for reconsideration/reprocessing of claims.
  • Prioritize workload, concentrating on priority work to enhance bottom-line results and achievement of the most important objectives.
  • Research, identify, and follow up on contract underpayments resulting from contract misinterpretation.
  • Maintain a collaborative relationship across all revenue cycle management departments.
  • Analyze trends in denials and coordinate with other revenue cycle management leaders on managing and resolving issues.
  • Perform audits to identify opportunities and trends, including Remittance Advices, write-offs, and adjustments.
  • Understand, develop, implement, and analyze key performance measures for continuous improvement, identifying specific trends or issues and communicating status and resolution with leadership.
  • Maintain continual knowledge of payor policies to ensure optimal reimbursement for all services performed within the system, in compliance with government and third-party payor regulations.
  • Participate in provider and third-party vendor conference calls regarding billing/reimbursement issues and trends, as well as Contract Interpretation and Joint Operating Committee meetings.
  • Recommend procedural and system changes to improve processes, operational quality, and efficiency, including job aids, training resources, and workflow, actively participating in process improvement projects.
  • Develop and recognize staff through coaching, planning, training, appraising, and counseling employees.
  • Conduct weekly AR team meetings and 1:1 meetings.
Requirements:
  • Demonstrated knowledge of Epic HB and/or PB workflow process, preferred.
  • Working knowledge of payer reimbursement methodologies.
  • Excellent communication skills, both written and verbal, presenting clear and concise information to a diverse audience.
  • Knowledge of government/non-government payor practices, including precertification, filing deadlines, claims processing, coverage issues, and other requirements.
  • Advanced level skills utilizing reporting data packages, including Excel.
  • Knowledge of managed care insurance, governmental health programs, HMOs, and their impact on professional, hospital, and post-hospital care reimbursement.
  • Working knowledge of medical terminology.
  • Computer, analytical, reporting, and organizational skills.
  • Must have knowledge of medical practice operations.
  • Advanced knowledge of claims management, HIPAA standards, CMS requirements, managed care, CPT, and HCPS coding.
  • Governmental legal and regulatory provisions related to claims resolution activities.
  • Skill in establishing and maintaining effective working relationships with other employees, patients, physicians, insurance organizations, and the public.
  • Requires a hands-on leader with the ability to prioritize, plan, and supervise Hospital and Professional Claims Follow-up Department.
Education and Experience:
  • Associate degree and/or 5+ years of experience in professional and hospital revenue cycle account receivable management, including government payers.
  • 2+ years in a related lead or supervisory role within professional and hospital centralized healthcare environment.
  • 3 years of experience in combined/comprehensive contract variance review/analysis.
Preferred Education:
  • Bachelor's degree in healthcare administration or related field of study.
  • Graduate of a medical billing program.
  • Medical coding experience and/or certification.
Performance Expectations:
  • Must be able to work independently and efficiently with little supervision.
  • Strong customer service and human relations abilities.
  • Ability to effect collaborative alliances and promote teamwork.
  • Ability to ensure a high level of customer satisfaction, including employees, patients, visitors, faculty, referring physicians, and external stakeholders.
  • Ability to use various computer applications, including EPIC.
  • Ability to make good judgments in demanding situations and react to frequent changes in duties and volume of work.
  • Must have a strong desire to teach/transfer knowledge to team members.
  • Ability to recognize, evaluate, solve problems, and correct errors.
  • Show proficiency in building and maintaining strong internal relationships while motivating and inspiring team members through effective consultative skills.
  • Ability to identify and implement process improvements to optimize revenue cycle performance.

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