GENERAL SUMMARY/BASIC PURPOSE OF JOB:

As part of the Revenue Cycle team the Manager of Denial Recovery is responsible for the overall transformational performance of denial management. Functions include but are not limited to, planning for performance improvement, data trending and analytics to drive decisions, critical thinking to get to true root cause, collaborate with all departments across the organization to course correct root causing, develop and monitor data driven key performance indicators to measure progress. The Manager of Denial Recovery will consistently demonstrate support of Sinai Health Systems Mission, Vision and Core Values by contributing to the team efforts and showing respect for and compassion for patients and their families, fellow employees, and all others with whom there is contract at or in the interest of the organization.

REPORTING RELATIONSHIPS: 

• Reports to: VP of Revenue Cycle
• Provides Supervision to: Denials Management Team 

ESSENTIAL FUNCTIONS AND DUTIES

• Develops strategies, oversees and coordinates the execution of denial reduction projects by collaborating with the leadership of key areas including, but not limited to Accounts Receivable, Financial Clearance, HIM/Coding/Revenue Integrity, Patient Access and Clinical Operations.
• Responsible for the development and execution of denial prevention plan that identifies root causes with proactive and sound approaches to reducing denials.
• Identifies and communicates payer-specific issues for escalation. Collaborates with managed care contracting team to identify systematically resolve patterns of underpaid claims with managed care organizations, insurance companies, and governmental programs.
• Create and consolidate denial management structure with monitoring; develop a methodology and committee structure to manage the performance of the denial management function and govern operational changes that may be necessary to prevent future denials in key areas including but not limited to Accounts Receivable, Financial Clearance, HIM/Coding/Revenue Integrity, Patient Access and Operations.
• Responsible for recruitment, development and performance management within areas of responsibility, translating the departmental vision into meaningful and effective results. Provides ongoing feedback to team regarding productivity and quality.
• Manages and prioritizes timely review, investigation and response to clinical denials and the required actions for appeals within contractual time frames.
• Facilitator and generator of new ideas and a mediator on difficult issues. Builds teamwork within Revenue Cycle.
• Subject matter expert while staying up to date on clinical regulations affecting denial prevention and management practice.
• Ensure measurement and achievement of KPI’s (key performance indicators) of the department and Revenue Cycle in general while devising strategic methodology to reach and maintain those goals.
• Develop departmental strategies to meet cash projection goals, reduce days in account receivable, and reduce denials.
• Perform other duties as assigned.