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Manager Denial Prevention

Fort Worth, TX 76103

Category: Other Area(s) Job Number: 41604 Location Requirements: Hybrid

Job Description

The Denial Prevention Manager is responsible for the analysis, interpretation, and identification of insurance denials and related performance variations and opportunities. This position develops mitigation strategies and oversees and coordinates the execution of prevention and 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. This position implements best practices to improve operational performance.

Responsibilities Include:
  • Responsible for the development and execution of a denials prevention plan that anchors denials resolution processes in the analyses of core analytics, identifying root causes, and identify proactive and sound approaches to reducing denials
  • Promotes collaborative practices with revenue cycle stakeholders and facilitates data sharing providing insight into focus areas, concentrated denial prevention, and management efforts
  • Identifies and communicates payer-specific issues for escalation.
  • Facilitates the dissemination of information regarding government and third-party payer regulations and requirements to clinical departments, coding, billing, revenue cycle management, and staff.
  • Collaborates with managed care contracting team to identify and systematically resolve patterns of underpaid claims with managed care organizations, insurance companies, and governmental programs.
  • Create a consolidated 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 all areas of the preaccess, patient access, registration, coding, and billing process from occurring.
  • Monitor, analyze, and assess denial management trends and coordinate mitigation and denial prevention activities when opportunities for improvement are identified
  • Devise new methods, procedures, and approaches to prevent denials across the organization and be able to introduce and gain support for process improvement.
  • Develop departmental strategies to meet cash projection goals, reduce days in accounts receivable, and reduce denials.
  • Manages staff and provides coaching, mentoring, and feedback. Maintains all timekeeping and payroll records and also identifies dependability issues.
  • Participates in Leadership Development Activities; implements strategies and processes to improve employee morale and performance.
  •  Provides ongoing feedback to the team regarding productivity and quality.

Required Qualifications:
  • Three (3) plus years progressive experience in Healthcare Management in a Revenue Cycle or Financial leadership or influence role required.
  • Two (2) plus years of experience using multiple healthcare information system applications and platforms.
Preferred Qualifications:
  • Five (5) plus years progressive experience in Healthcare Management in a Revenue Cycle or Financial leadership or influence role required.
  •  Five (5) plus years of experience using multiple healthcare information system applications and platforms.

Knowledge, Skills and Abilities:
  • Thorough knowledge of all Revenue Cycle processes and standards related to billing, collections, and cash posting.
  • Knowledge of regulatory requirements related to billing and collections, including a solid understanding of Medicare, Medicaid and all third party payers.
  • Knowledge of and experience computer systems, software, technology, and automated systems.
  • Ability to read analyze and interpret financial reports, contracts, and other legal documents.
  • Data driven analytics are required to manage, trend, and target opportunities for improvement.
  • Ability to present detailed information to leadership in an effective, organized manner that is highlevel and easy to understand.
  • Ability to set and maintain priorities when dealing with multiple demands and interruptions.
  • Skill in time management, including prioritizing, organizing, and coordinating multiple work areas and assignments under fast paced and changing conditions to meet deadlines.
  • Skill at communicating, coaching, and providing feedback to persons representing varied educational levels and cultural backgrounds.
  • Dedication to the development of others and willingness to coach and mentor people as necessary to promote their personal and professional growth.

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Melissa Fyffe

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