Back to Search Results
Get alerts for jobs like this Get jobs like this tweeted to you
Company: MedStar Health
Location: MD
Career Level: Director
Industries: Not specified

Description

About the Job

General Summary of Position
The Director Denial Management & Prevention is responsible for directing and administering the programs and activities of a denial prevention and recovery operations. In partnership with the VP Clinical Resource Management the Director will lead planning and execution of strategic initiatives around technical and clinical/medical necessity denials and appeals across system hospitals.

Primary Duties and Responsibilities


  • Collaborates with VP Clinical Resource Management and other leaders to identify denial mitigation opportunities andreimbursement improvement processes.
  • Oversees and directs appeals for the system to include oversight of any appeal vendors.
  • Partners with system leaders to create implement and sustain improvements that contribute to the organization's goals.
  • Provides strategic direction and clinical oversight for hospital denials and appeal operations and outcomes.
  • Works with organization leaders to develop performance goals and objectives based on industry best practices andsystem benchmarks.
  • Develops and maintains analytics and dashboards to standardize entity denial summaries.
  • Supports system denial mitigation projects and serves as a consultant for individual entities regarding denial trends andinterventions.
  • Works with Acute Case Management teams focusing on operational improvements and team education to support denialreduction.
  • Collaborates with the Managed Care team to summarize and address payer opportunities.
  • Works with Corporate Compliance and Rates and Reimbursement team to ensure operations and policies conform tocurrent governmental and state regulations.
  • Manages business partner/vendor contracts holding them accountable to contractual obligations and both industry andorganizational benchmarks.
  • Supports the optimization of technology to enhance operational efficiency and improve reimbursement.
  • Minimal Qualifications
    Education
    • Bachelor's degree in Nursing required
    Experience
    • 5-7 years 5-7 years of Revenue Cycle experience including appeals and financial clearance required and
    • Leadership experience in the healthcare industry with emphasis on revenue cycle preferred
    Licenses and Certifications
    • RN - Registered Nurse - State Licensure and/or Compact State Licensure required
    Knowledge Skills and Abilities
    • Team builder with excellent interpersonal skills
    • Strong analytical and problem-solving skills with high level of accuracy and attention to detail.
    • Strong verbal and written communication skills including presentation skills with ability to effectively interact with all levels of management internal departments and external agencies.
    • Computer skills are required to be efficient in managing data (Word PowerPoint Excel and email programs). Advance Microsoft Excel skills.

    This position has a hiring range of

    USD $114,004.00 - USD $219,960.00 /Yr.


     Apply on company website