Find your WHY at Reid Health

This position assumes responsibility and accountability for managing denials for third party payers as well as denial prevention and education. This includes overseeing the denial process and continually working to identify opportunities for workflow improvements.

Our values of Excellence, Empathy, Integrity and Accountability are essential to exceed our customers’ expectations. At Reid, we look for individuals who believe in our core values and demonstrate a genuine desire to make a positive impact to those we serve. We take pride in employing people who show up every day with a commitment to these values along with our mission and vision. We are one team working toward a common goal of providing outstanding customer care and service to our communities. If you have a calling to serve and are looking for meaningful and purposeful work, Reid Health is the place for you.

To lead our communities to well-being, one person at a time. It is not just what we do – it is who we are.

Overview of Responsibilities

• Oversees the work of the denials prevention staff and is responsible for ensuring their work output is satisfactory and their concerns are resolved.
• Identifies problem areas and develops plan of action to ensure benchmark standards are obtained and maintained.
• Serves as the face of denials prevention across the organization.
• Monitors and assesses denial trends to identify improvement opportunities.
• Forecasts and measures cost savings and revenue enhancement associated with denials prevention initiatives and improved denial performance.
• Provides actionable data and reporting to stakeholders to illustrate denials performance.
• Manages denial’s function and supervises the denials team.
• Ensures timely and accurate capture and reporting of denials write-offs and other metrics such as root cause analysis.
• Coordinates the monthly Denials Prevention Committee meeting and engages regularly with stakeholders who impact denial performance. Collaborates and works in partnership with the committee chairman.
• Works with Decision Support to maintain and ensure accuracy of the Denials Power BI tool.
• Devises new methods, procedures, and approaches to prevent denials across the organization; introduce and gain support for operational process improvement.
• Communicates any barriers/challenges in denials prevention to leadership.
• Develops effective denial management policies and procedures, trainings, communications, and awareness materials with a denials prevention mindset.
• Monitors regulatory and payer changes with may impact the denials management program.
• Meets regularly with staff to ensure productivity and accuracy and to ensure consistency in quality and quantity while meeting department and organizational goals.
• Recommends changes to Director as needed to help increase staff performance and maintain quality.
• Oversees the distribution of work assignments among staff and assists in determining work priorities.
• Interviews and makes recommendations regarding hiring, promoting, or disciplinary action involving staff.
• Completes performance appraisals and quarterly progress reports for assigned staff.
• Encourages employee participation in performance improvement by listing and giving feedback with respect to departmental needs.
• Updates and creates new policies as needed in conjunction with the revenue cycle management team.
• Follows compliance with all laws, regulations, and guidelines of federal and state programs with an emphasis on prevention of fraud, waste, and abuse.
• Position includes other duties and projects as assigned to support goals and outcomes consistent with department expectations.
• Attends meetings as requested.

Education/Experience

Education Required:

• Baccalaureate or Associate degree or diploma in nursing from an accredited School of Nursing.

Experience Required:

• A minimum of 2 years’ experience in denials management, healthcare performance improvement and/or healthcare revenue cycle leadership.
• 5 years nursing experience in an acute care setting.
• Supervisory experience, which includes experience in hiring, training, evaluating, disciplining, and developing staff.

Licensure/Certification: Registered Nurse

Other:

• Must be detail-oriented and organized, with good analytical and problem-solving ability.
• Must maintain a professional appearance and demeanor.
• Ability to function independently and as a team player in a fast-paced environment required.
• Ability to work successfully with changing priorities and deadlines.
• Knowledge of Epic.
• Ability to communicate in a positive/professional manner both orally and written.

Schedule Details

What We Offer

Unexpected Perks - Daycare, Doordash, SmartDollar, Daily Pay, therapy dogs, massages, Forbes rated Best Places to Work 2022

Stay Connected

Not quite what you are looking for? Submit your information here for general consideration. One of our employment specialists will be in touch with next steps.

Other Information

EEO Statement: Reid Health is an Equal Opportunity Employer

No Search Firms:

Reid Health does not accept unsolicited assistance from search firms for employment opportunities. Please do not call or email. All resumes submitted by search firms to any employee or other representative at Reid Health via email, the internet or in any form and/or method without a vaild written search agreement in place and approved by HR will result in no fee being paid in the event the candidate is hired by Reid Health. 

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