Director of Denial Management

1 week ago


Greenville, North Carolina, United States Vidant Health Full time
Job Title: Director of Denial Management

About the Role:

The Director of Denial Management is a key leadership position responsible for overseeing the denial management process, ensuring optimal reimbursement, and regulatory compliance. This role requires a strong understanding of payer policies, procedures, and regulations.

Key Responsibilities:

  • Lead and manage denial management teams to ensure efficient and effective denial resolution.
  • Develop and implement strategies to improve denial rates and revenue recovery.
  • Collaborate with leadership, medical staff, and revenue cycle entities to ensure optimal reimbursement and regulatory compliance.
  • Monitor and track meaningful metrics to assess performance and validate KPIs.
  • Develop and manage initiatives to ensure operations align with organizational goals.
  • Oversee client denials prevention deliverables in partnership with internal and external business relationships.
  • Partner with enterprise operations leaders to recommend and implement changes to processes, tools, and methodology.
  • Hire, orient, train, and conduct performance evaluations for team members.
  • Manage successful recoveries of denied dollars from insurance carriers.
  • Minimize overtime expenses and maintain budget levels.

Requirements:

  • Bachelor's degree and/or 15+ years related work experience.
  • 5+ years of applicable EPIC Revenue Cycle experience.
  • Minimum of ten to fifteen years of progressive experience in appeal/denial management required.
  • 15 or more years of leadership experience in a directly related role.
  • 10 or more years of experience in billing, A/R follow-up.

Preferred Education:

  • Certifications or credentials in EPIC Resolute HB, EPIC ADT Prelude, AAPC, AHIMA, and HFMA.

Performance Expectations:

  • Illustrate autonomous, best revenue cycle practices.
  • Illustrate proficiency in the use of all internal automation and software applications.
  • Illustrate accuracy and consistency through Quality Review results of all audit documentation.
  • Demonstrate ability to effectively manage multiple projects with innovation, creativity, and vision.
  • Investigating and documenting any potential for new program and product development.
  • Documenting results of all special project work and providing recommendations for revenue managing opportunities relating to special projects.
  • Illustrating creative problem-solving skills through documentation of process improvement reporting and/or internal reporting mechanisms.


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