Supervisor, Clinical Denials & Appeals

Position Summary

• Coordinates and directs the daily activities of the Clinical Appeals Specialists responsible for appeals on denied claims for ECU Health System.
• Determines professional learning needs of staff and identifies short/long-term goals relevant to position.
• Reviews and evaluates daily work queue inventory to ensure adequate and timely follow up is performed and the workload is equally distributed.
• Reviews and approves contractual, administrative and legally unbillable adjustments in accordance with the policy.
• Stays current on all of the contractual agreements with third party payers and represents area in payer escalation/relation meetings.
• Liaison for Managed Care reimbursement resolution.
• Responsible for ongoing staff training & development, scheduling, performance evaluations and time and attendance.
• Assists in hiring of staff.
• Stays current on the federal, state & local government regulations and the claim reimbursement & denials.
• Performs other related responsibilities to assist manager as required or requested.
  
  

Responsibilities

• Ensures that the policies and procedures are followed:
• Ensures that the policies and procedures pertaining to department & health system are being followed in order to effectively work and resolve incoming denial inventory in a timely manner with a focus on collaborative denial prevention opportunities to increase the profitability of the health system.
• Evaluates and ensures Ins Reps are performing duties:
• Evaluates and ensures that adequate and timely follow-up on accounts is being performed by each Denials Specialist. Tracks and trends weekly time trackers and productivity reports, reviewing monthly with each team member and addressing workflow gaps, inconsistency in effort or productivity, or any other efficiency opportunities.
• Reviews/approves adjustments in Supervisor Adjustment WQ:
• Reviews and approves adjustments requests within approval threshold based upon accuracy of adjustment request, returning any requests that have not been thoroughly worked or do not provide enough suppotint documentation for adjustment request. All adjustments are made in accordance with established policies.
• Supervises Staff and interviews/hiring of new employees:
• Assists in the screening, interviewing, and hiring of applicants. Assists new employees in their onboarding, training, and development. Responsible for the monitoring and performance evaluations of employees. Reviews scheduling and approves time and attendance in a manner that ensures appropriate staffing levels within the department.
• Reviews, analyzes, and communicates payer and Governmental communications and/or bulletins:
• Reviews, analyzes, and communicates bulletins with manager and denials team to remain proactive and to mitigate any negative impact on reimbursement for ECU Health System.
• Responds to special request by management:
• Performs in accordance with accepted procedures and policies and responds to special requests by management in a timely and accurate manner.
• Adheres to the policies and procedures:
• Adheres all policies and procedures to include HIPPA ensuring protection of PHI. Uses tact and courtesy in all interactions including but not limited to staff, patients and payers.
• Promotes a positive image and supports management in goals and objectives. Handles inquiries and complaints timely, discreetly and effectively.
• Supervises RNs.

Minimum Requirements

• Bachelor's degree or higher is required.
• 3 to 4 years of experience in insurance/denials is required.
• ADN degree required. A BSN degree can substitute for an ADN degree.
• Two years of experience beyond 4 years can substitute for the Associates degree.
• RN Licensure required.

Pay Range

$68,806.40 - $100,294.48/year

Other Information

• Remote role (based out of Greenville, NC)
• Monday - Friday, full-time, day shift
• Great Benefits
  
  

ECU Health

About ECU Health

ECU Health is a mission-driven, 1,708-bed academic health care system serving more than 1.4 million people in 29 eastern North Carolina counties. The not-for-profit system is comprised of 13,000 team members, nine hospitals and a physician group that encompasses over 1,100 academic and community providers practicing in over 180 primary and specialty clinics located in more than 130 locations.

The flagship ECU Health Medical Center, a Level I Trauma Center, and ECU Health Maynard Children¿s Hospital serve as the primary teaching hospitals for the Brody School of Medicine at East Carolina University. ECU Health and the Brody School of Medicine share a combined academic mission to improve the health and well-being of eastern North Carolina through patient care, education and research.

General Statement

It is the goal of ECU Health and its entities to employ the most qualified individual who best matches the requirements for the vacant position.

Offers of employment are subject to successful completion of all pre-employment screenings, which may include an occupational health screening, criminal record check, education, reference, and licensure verification.

We value diversity and are proud to be an equal opportunity employer. Decisions of employment are made based on business needs, job requirements and applicant¿s qualifications without regard to race, color, religion, gender, national origin, disability status, protected veteran status, genetic information and testing, family and medical leave, sexual orientation, gender identity or expression or any other status protected by law. We prohibit retaliation against individuals who bring forth any complaint, orally or in writing, to the employer, or against any individuals who assist or participate in the investigation of any complaint.