What are the responsibilities and job description for the Denials Management and Prevention Manager position at CarolinaEast?
About CarolinaEast Health System
CarolinaEast Health System is committed to providing high quality, compassionate care across the Coastal Carolina region. At the heart of our system is a 350-bed, full-service medical center equipped with a comprehensive range of inpatient and outpatient services, utilizing the latest medical technologies. We employ over 3,200 dedicated team members and operate physician practices across various specialties in four counties. Our employees foster a culture of excellence that ensures our patients receive the same high level of care found at larger medical centers, all while maintaining a friendly, community-centered atmosphere throughout our facilities. CarolinaEast offers a robust benefits package to all full-time employees, as well as benefits for part-time plus and part-time staff. We are proud to be the first medical center in North Carolina recognized as a Cardiovascular Center of Excellence by the American College of Cardiology and the American Heart Association. Additionally, we are honored to be named one of America's Best-In-State Hospitals by Newsweek, among numerous other prestigious accolades.
Job Summary: Responsible for providing overall insight, management, prevention and resolution of selected audits/denials for Government, Managed Care, Non-Government and Commercial plans. The manager is responsible for maintaining compliance with government payer regulations and commercial payer requirements. The manager will also oversee Variance Analysis and Access Management Programs to ensure the quality and productivity for these programs as well as the impact on the organization's revenue.
Minimum Requirements:
- Bachelor's Degree in Nursing
- Current North Carolina RN Nursing License
- Five to seven (5-7) years of relevant work experience required, including clinical experience in a hospital or healthcare related environment
- Three to five (3-5) years in denials management, utilization review or related Revenue Cycle experience
- Leadership experience and experience with EPIC and MIDAS Systems Preferred.
- Deliver outstanding customer service that upholds CarolinaEast's Standards of Excellence.