Manager, Denial Management

Overview

Our team members are the heart of what makes us better.

At Hackensack Meridian Health we help our patients live better, healthier lives — and we help one another to succeed. With a culture rooted in connection and collaboration, our employees are team members. Here, competitive benefits are just the beginning. It’s also about how we support one another and how we show up for our community.

Together, we keep getting better - advancing our mission to transform healthcare and serve as a leader of positive change.

The Manager, Denial Management, is responsible for the daily operations, financial oversight, and efficient performance of the Managed Care department. This role emphasizes managing accounts sent, ensuring corrections are applied, and reducing accounts received through proactive oversight. This position directly oversees denial processes, serves as the subject matter expert in Contract Management, and leads initiatives to prevent denials while improving account management efficiency. Additionally, develops and monitors reporting and benchmarks across hospitals and the network, ensuring alignment with efficiency metrics and organizational performance goals.

Responsibilities

A day in the life of a Manager, Denial Management at Hackensack Meridian Health includes:

• Manages Denial Dashboard for the HMH Network with Primary oversight for strategic decision making for all automation of process. Achieved through: a. Investigation and resolution of problems to ensure coordinated efforts; works closely with the Revenue Cycle Department to mitigate AR aging & Denials. b. Building strong working relationships with applicable parties within HMH and external vendors. c. Manage the Medical & Technical Denials (where appropriate) denials - work closely with Case Management, Utilization Review, Physician Advisors, Registration/Access & other departments that have impact on Denials. d. Identify variables in getting full payments & recommend solutions to accelerate revenue. Denials are analyzed, posted, and routed to the appropriate areas. e. Manage all Dashboards related to Denial Management
• Perform duties which guide the management of the under/over payments, adjustment and denial posting and processing of credit balances functions of the business offices for the HMH Network. a. Ensures that Denial work queues (WQ) are maintained to ensure smooth flow of accounts based on the needs of the department. b. Ensure that accounts are denied correctly based on Contract Management as this is crucial in preventing accounts aging or denying incorrectly. c. Building of strong working relationships with IT (Information technology) to expedite resolution pertaining to Contracts. d. Current payer trends, rules and regulations by Medicare, Medicaid and Commercial Payers. e. Establish a regular meeting with the pay representative to resolve and/or escalate payment variance.
• Collaboration with the corporate finance team to ensure understanding of revenue cycle transactions as well as proper revenue cycle financial reporting.
• Develops, revises, publishes, and monitors reports to support the Denial team. Includes, but is not limited to medical denials, technical denials and Bad Debt reports. Where necessary, implement corrective action plans.
• Maintains and supports a cross-functional matrix with internal and external customers for Population Health, including but not limited to Case Management, Finance, and Patient Financial Services teams.Disseminates and communicates policy changes and guidelines from the payers.
• Works collaboratively with Revenue Cycle Training Manager to design, develop and administer educational training programs.
• Develops and implements quality assurance measurements and standards, including completion of internal and external audits. Responsible for yearly external audit by PWC (or other entity engaged to conduct the yearly audit) as it relates to Revenue Operations-related questions. Respond to payer audit requests.
• Audit manual adjustment performed by Revenue Operations staff to determine if there is an issue that needs to be addressed. Perform staff audit to ensure allowance or balance are being done correctly and the team is in compliance with the set guidelines of processing debit or credit variance Develops, revises, publishes, and monitors reports to support the Denial team. Includes, but is not limited to medical denials, technical denials and audit reports. Where necessary, implement corrective action plans. Maintains strong relations with the Case management team. 
• Disseminates and communicates policy changes and guidelines from the payers.
• Develops and implements quality assurance measurements and standards, including completion of internal and external audits. Responsible for yearly external audit by PWC (or other entity engaged to conduct the yearly audit) as it relates Managed Care-related questions. Respond to payer audit requests. 
• Audit manual adjustment performed by revenue operations staff to determine if there is an issue that needs to be addressed. Perform staff audit to ensure allowance or balance are being done correctly and the team is in compliance with the set guidelines for processing debit or credit variance.
• Collaborate with the Training department if process changes must be developed based from discovery, new technology, change in payer rules or change in internal processes. a. Handles the development of reporting tools for management utilizing the current information system and/or identifying other software programs to achieve desired reporting outcomes. b. Requests, obtains, and distributes monitoring reports (ad hoc), Reporting Workbench, Radar, BI reports to the appropriate leaders and supervisor the ultimate delegation to review and subsequent staff assignment. c. Performs data mining and in-depth analysis of root cause of payment variance or denial. 
• Recruits and selects talent and manages staff in the HMH Network. Formally evaluates performance and professional development of staff. Performing disciplinary actions where necessary. Other duties and/or projects as assigned. 
• Other duties and/or projects as assigned.
• Adheres to HMH Organizational competencies and standards of behavior.

Qualifications

Education, Knowledge, Skills and Abilities Required:

• Bachelor's degree in finance related area of concentration or business administration with concentration in finance or management.
• Minimum of 4 or more years of experience in Healthcare/Billing/Collections/Managed Care/Revenue Cycle.
• Minimum of 2 or more years in managerial role.
• Proficiency with Windows applications, particularly in Excel, as well as Hospital Billing systems, SMS and EPIC. 
• Strong report writing skills, outcome driven and technology savvy.
• Strong knowledge of healthcare industry revenue integrity key performance indicators and best practices.
• Change agent, capable of guiding teams in initiating change management initiatives with a view of leading and guiding towards the future, but respectful of organizational history and culture.
• Strong multi-tasking skills and the ability to work at multiple facilities.
• Ability to gather complex data, compile usable information and prepare reports that are understandable by members of the organization.
• Excellent written and verbal communication skills. 
• Proficient computer skills that include but are not limited to Google Suite and/or Microsoft Office platforms.

Education, Knowledge, Skills and Abilities Preferred:

• Resolute Hospital Billing.
• Reporting Workbench.

If you feel that the above description speaks directly to your strengths and capabilities, then please apply today!

Compensation
Minimum rate of $111,924.80 Annually

HMH is committed to pay equity and transparency for our team members. The posted rate of pay in this job posting is a reasonable good faith estimate of the minimum base pay for this role at the time of posting in accordance with the New Jersey Pay Transparency Act and does not reflect the full value of our market-competitive total rewards package.

The starting rate of pay is provided for informational purposes only and is not a guarantee of a specific offer. Posted hourly rates may be stated as an annual salary in the offer and posted annual salaries may be stated as an hourly rate in the offer, depending on the level and nature of the job duties and credentials of the candidate. The base compensation determined at the time of the offer may be different than the posted rate of pay based on a number of non-discriminatory factors, including but not limited to:

• Labor Market Data: Compensation is benchmarked against market data to ensure competitiveness.
• Experience: Years of relevant work experience.
• Education and Certifications: Level of education attained, including specialized certifications, credentials, completed apprenticeship programs or advanced training.
• Skills: Demonstrated proficiency in relevant skills and competencies.
• Geographic Location: Cost of living and market rates for the specific location.
• Internal Equity: Compensation is determined in a manner consistent with compensation ranges for similar roles within the organization.
• Budget and Grant Funding: Departmental budgets and any grant funding associated with the job position may impact the pay that can be offered.

Some jobs may also be eligible for performance-based incentives, bonuses, or commissions not reflected in the starting rate. Certain positions may also be eligible for shift differentials for work performed on evening, night, or weekend shifts.

In addition to our compensation for full-time and part-time (20 hours/week) job positions, HMH offers a comprehensive benefits package, including health, dental, vision, paid leave, tuition reimbursement, and retirement benefits.

HACKENSACK MERIDIAN HEALTH (HMH) IS AN EQUAL OPPORTUNITY EMPLOYER

All qualified applicants will receive consideration for employment without regard to age, race, color, creed, religion, sex, sexual orientation, gender identity or expression, pregnancy, breastfeeding, genetic information, refusal to submit to a genetic test or make available to an employer the results of a genetic test, atypical hereditary cellular or blood trait, national origin, nationality, ancestry, disability, marital status, liability for military service, or status as a protected veteran.

Our Network

Hackensack Meridian Health (HMH) is a Mandatory Influenza Vaccination Facility

As a courtesy to assist you in your job search, we would like to send your resume to other areas of our Hackensack Meridian Health network who may have current openings that fit your skills and experience.

Salary : $111,925