This leader has accountability and oversight, and supervises the daily activities of the Denials, Appeals, and Recovery department. In this role, the leader sets the tone and models positive leadership behavior, while ensuring individual and teamwork tasks, projects, and responsibilities are completed successfully in support of departmental, organizational goals.
Required Qualifications:- Bachelor’s degree required. Relevant work experience can substitute on a year-for-year basis for the required degree.
- Require a minimum of ten (10) years of managed care, appeals/denials and/or reimbursement schedules experience, in which, five (5) years are in written appeals.
- Required Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) certification by the American Health Information Management Association (AHIMA).
- Prefer knowledge of Medicare National Coverage Determinations (NCD) and Local Coverage Determination (LCD) protocols for medical necessity/Advanced Beneficiary Notice (ABN).
- Prefer demonstrated leadership skills and understanding of group processes, teamwork, and cost center based management.
- Prefer demonstrated knowledge of International Classification Determination Tenth Revision (ICD-10), Current Procedural Terminology (CPT), Diagnosis-Related Groups (DRG), Healthcare Common Procedural Coding System (HCPCS), and Revenue codes.
- Prefer knowledge of insurance rules and regulations including Medicare, Medicaid, Managed Care and Commercial Insurance.
- Prefer familiarity with Florida statutes as they pertain to managed care operations.
- Prefer familiarity with managed care contracts and policies/procedures as well as overall operations.
- Prefer demonstrated ability in establishing and maintaining effective working relationships.
- Prefer demonstrated ability to analyze problems and consistently follow through to solution.
- Prefer demonstrated ability to take initiative and exercise independent judgment, decision-making, and problem solving expertise.
- Prefer demonstrated effective oral and written communication skills at all levels.
Onsite position. Monday through Friday.
Sarasota Memorial Hospital was recently recognized again by ranking #1 Hospital in the Region by the U.S. News's Best Hospital report by scoring a Perfect 10! Not only that, but SMH was also designated at a national "standout" hospital for earning top ratings in all evaluated conditions and procedures - an accomplishment achieved by less than 1% of the 4000+ hospitals. Our system has also earned Magnet® recognition from the American Nurses Credentialing Center (ANCC), as well as these additional accolades: Gallup Great Workplace 2018; recipient of an "A" grade for Patient Safety. Sarasota Memorial Hospital is Magnet designated and the only provider of Level II trauma services, obstetrical services, and Level III neonatal intensive care in Sarasota County.
Reputation. Community. Impact. Growth.
Every day, our patients at Sarasota Memorial Health Care System receive a first-class experience in care from a team on a mission to deliver the highest level of care in America. In the process of rising to that challenge, one by one, our people are finding their purpose and feeling their impact. Now it is your turn to see yourself here.
Recognition:
* 5- Star Quality Rating- SMH- Sarasota is the only hospital in Florida to earn the federal Centers for Medicare & Medicaid Services' highest rating every year since its inception.
* 50 Best Hospitals- SMH ranked among U.S. News & World Report's 50 Best Hospitals in two specialties, Rehabilitation and Obstetrics/Gynecology in 2023-2024, and among the nation's top 10% high performers in 18 other medical specialties, procedures and conditions.
* World's Best Hospitals- SMH- Sarasota has made Newsweek's prestigious list six years in a row, since the global rankings began in 2019.
* "A" for Patient Safety- SMH- Sarasota has earned straight A's since it began participating in the Leapfrog Group's hospital safety survey in 2016.
* Magnet Hospital- SMH has been recognized as a Magnet hospital for the past 20 years by the American Nurses Credentialing Center, a continuous achievement for nursing excellence shared by less than 1% of hospitals nationwide.
* America's Best Employer/Workplace- SMH topped Forbe's list of America's Best Employers, ranking among the top 20% of large employers across all industries in 2024, and #1 healthcare employer in Florida in 2023. The health system also earned a 5-star rating in Newsweek's 2024 list of "America's Greatest Workplaces for Women."
The benefits of being the best:
Our commitment to becoming the best community hospital and health care system means providing the best possible benefits to our people. Some highlights:
Total Rewards Package