What are the responsibilities and job description for the Denials Manager-Hybrid position at Spartanburg Regional Healthcare System?
Job Requirements
Position Summary
The Denials Manager will be accountable for the oversight of the SRHS denial management program and for conducting analysis of denials and denial trends by type and payer. This position will be responsible for the coordination of the appeals process - inclusive of clinical, administrative denials and first level clinical review of RAC (Recovery Audit Contractor) accounts. This position is also responsible for monitoring, tracking, and trending Medicare ADRs (Additional Document Requests). Works with the Director of Patient Financial Services, Collection Manager, Billing Manager, Director of Case Management, and other applicable management to champion the denials management process by leading a denial management committee to ensure key stakeholders are accountable for denials reductions performance.
Minimum Requirements
Education
Preferred Education
Position Summary
The Denials Manager will be accountable for the oversight of the SRHS denial management program and for conducting analysis of denials and denial trends by type and payer. This position will be responsible for the coordination of the appeals process - inclusive of clinical, administrative denials and first level clinical review of RAC (Recovery Audit Contractor) accounts. This position is also responsible for monitoring, tracking, and trending Medicare ADRs (Additional Document Requests). Works with the Director of Patient Financial Services, Collection Manager, Billing Manager, Director of Case Management, and other applicable management to champion the denials management process by leading a denial management committee to ensure key stakeholders are accountable for denials reductions performance.
Minimum Requirements
Education
- High School Diploma or equivalent
- Case Management Utilization experience strongly desired
- Medical claims financial auditing experience
- Proficiency with Microsoft Office Suite required, and familiarity with hospital patient accounting systems
- N/A
Preferred Education
- Bachelor Degree in Business, Healthcare Administration or Finance, or 10 years’ Revenue Cycle denials experience.
- Previous supervisory experience
- Five Years of broad Revenue Cycle experience or deep denial management experience
- Medicare and claims processing experience
- N/A
- Assures timely action is taken on all denials by coordinating prompt appeals with payers
- Responsible for tracking, oversight, and maintaining a database of denials and appeal results
- Acts as a liaison and facilitates denial related communication between Patient Financial Services and all applicable service departments so that performance, areas of concern, and expectations can be addressed through all levels of responsibility
- Has supervisory responsibility of the Denial Collectors in the Business Services department.
- Ability to support the Director of Patient Financial Services, Collection & Billing Managers, and Denial Management Committee members with key reporting and trending relating to the denial management process
- Demonstrated ability to communicate proactively to prevent problems and negotiates effectively to resolve conflict
- Demonstrated knowledge of managed care payer requirements in an acute care setting
- Demonstrated ability to facilitate team / group activities and demonstrated leadership qualities including professional verbal and written communication skills
- Demonstrated ability to be flexible and adept at prioritizing workload, decision-making skills, and professional development through participation in continuing education and professional organizations.
- Strong organizational and coordination skills
