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Manager of Clinical Denials
3 weeks ago
Job Responsibilities:
- Management and coordination of the Clinical Denials Process.
- Assisting in the overall planning, organization, and direction of the daily work assignments for the preparation of Clinical Appeals based upon evidence-based criteria documented within the medical record.
- Conducts analysis on Clinical Denials and Appeals, identifying and presenting both Documentation Improvement and Revenue Protection opportunities.
- Serve as a subject matter expert while staying up to date on clinical regulations affecting Denial Prevention and Management practice.
- Provide Orientation, Training and Education to Clinical Denials and Appeals staff.
- Manage a team of 16. Oversee workflow and productivity. Work with client relationships.
- Manages and prioritizes timely review, investigation and response to Clinical Denials and the required actions for appeals within contractual timeframes.
- Identify, monitors, and presents monthly denial performance trends utilizing case Identifies potential risk for loss reimbursement related to medical policies and prior authorization requirements.
- Create and analysis reports
- Maintaining and developing relationships with clients.
- Ability to expand current scope of work with clients or add to client base by expanding work into other hospital affiliates.
- Ability to work with other service lines within the company, for example outpatient recovery to provide enhanced revenue opportunity to clients.
- Coordinate reports and materials and participate in quarterly status meetings with clients.
- Involvement in NY HFMA
- Bachelors Degree or other Clinical Practice field
- 5+ years experience including 5 years in Denial Management, Case Management, or related experience and 3 years of current experience with reimbursement methodologies
- Ability to work collaboratively in a team environment
- Ability to handle multiple assignments and carry out work independently with minimal supervision
- Competitive salary, great benefits, and other attractive incentives
- Generous PTO
- All major insurances (health, life, disability)
- Work-life balance is valued
- A team environment that believes in employee development, professional growth, and company longevity
- Culture is one of mutual respect, teamwork, and equality
- The organization embraces and values an inclusive work environment
If you are passionate about what you could accomplish in this role, we would love to hear from you
#LI-FP1
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