Denials Director

US-KY-Louisville
Req No
2017-4183
Type
Perm Placement

Overview

Executive resource for claims denied by third-party and governmental payers. This position will collaborate with Revenue Cycle Leadership, Case Management and clinical service areas to proactively develop strategies to prevent, reduce the denial rate and manage denials, i.e. related to medical necessity, timely filing, missing/invalid authorizations, DRG disputes, RAC audits, Inpatient Only procedures, non-covered services, coding and/or documentation.

This position will maintain reporting and collaborate with the Payor Relations and Contracting Department during contract negotiations and settlements on denial issues impacting payment from third party payers for consideration.

 

Peak Health Solutions, an AMN Healthcare company, is an EEO/AA/Disability/Protected Veteran Employer We encourage minority and female applicants to apply

 

Responsibilities

  • Participate in system testing and training
  • Research payer Medical policy coverage issues and provides guidance to resolve or prevent denials
  • Review and analyze denied claims, i.e. denials created the most from a specific payer, type of denial, high dollar denials, high-cost drugs and implants
  • Focus on denials that are the most likely to result in write-offs – lost revenue
  • Provide education on regulations, systems, and billing requirements impacting claims from being paid
  • Implement processes to reduce denials across the organization
  • Determine “root causes” of denials
  • Recommend and implement solutions so initial claims will be paid in a timely manner
  • Works with insurance carriers on appeal issues
  • Collaborate with HIM Director on feedback to the coding department with coding errors or updates
  • Point of contact for underpayment reviews and payer modeling
  • Track audits and report monthly to the Revenue Cycle leadership
  • Reviews denials for accuracy
  • Monitor, track and analyze new denials
  • Assure RAC correspondence is received, maintained and appeals are submitted
  • Escalates issues to Case Management and Revenue Cycle leadership as necessary

This document represents the major duties, responsibilities, and authorities of this job, and is not intended to be a complete list of all tasks and functions. Other duties may be assigned.

MINIMUM EDUCATION & EXPERIENCE

  • Bachelor’s Degree in Accounting, Business, Business Administration, or similar area
  • 3 years of denials management, auditing, accounts receivable management or healthcare management experience, or equivalent experience required.

KNOWLEDGE, SKILLS, & ABILITIES

  • Knowledge of reading and interpreting third-party payor contracts
  • Critical thinking skills
  • Strong oral and written communication skills
  • Basic Microsoft Office knowledge
  • Ability to foresee projects from start to finish

WORKING CONDITIONS

  • Sedentary Work: Lifting 10lbs. maximum and occasionally lifting and/or carrying items as needed.
  • Frequent Talking (Expressing or exchanging ideas by means of the spoken word.)
  • Frequent Hearing (Perceiving the nature of the sounds by the ear.)
  • Frequent Seeing (Visual acuity, depth perception, field of vision, color vision).
  • Consistent use of hand movement for keyboarding purposes.

 

 

 

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