Overview
Manages the daily operations of the patient financial services team to ensure accurate and efficient billing and collections. Coordinates with healthcare providers and insurance companies to resolve billing issues and expedite payments. Monitors patient accounts for compliance with financial policies, trains staff on handling inquiries and payment plans, and implements process improvements to optimize revenue cycle management. Requires reviewing financial reports to identify trends and collaborating with other departments to streamline patient registration and insurance verification, all while maintaining strict confidentiality and data protection standards.
Responsibilities
Key Responsibilities
Manage and oversee all payer denial activities to support low denial rates and optimal reimbursement.
Direct daily operations of the denial management process and identify opportunities for workflow and process improvements.
Establish departmental goals, measure process effectiveness and productivity, and identify the need for updated policies and procedures.
Plan and organize projects aimed at improving billing effectiveness, reimbursement rates, and appeal turnaround times.
Perform denial trend analysis, including:
Epic system edits
Coding validation
Charge Description Master (CDM) processes impacting reimbursement
Authorization trends and performance improvement
Payer-specific denial trends
Collaborate with the Enterprise Clinical Denial Assistant Manager to educate departments on proper charging, billing, and coding practices to ensure regulatory compliance.
Partner with Managed Care and Compliance teams to resolve issues involving departments and payers.
Report to the Enterprise Senior Denial Manager.
Provide support across the revenue cycle, including:
Clinical departments
Patient Financial Services
Revenue Integrity
Managed Care
Lead and support the Clinical Denial team.
Qualifications
Required Education
Preferred Education
Necessary Skills
Demonstrated knowledge of hospital billing and reimbursement processes, including denials and appeals, third-party contracts, insurance protocols, delay tactics, systems, and workflows, as well as federal and state healthcare regulations.
Ability to take initiative by identifying problems, developing solutions, and implementing process improvements.
Strong time-management skills with the ability to multitask effectively in a fast-paced environment with tight deadlines.
Proven leadership abilities, including conflict resolution and excellent customer service skills.
Exceptional written and verbal communication skills.
High level of proficiency with computer systems, including Microsoft Office applications (Word, Excel, Outlook, PowerPoint).
Required Licensure/Certifications
Preferred Licensure/Certifications
Required Experience
Three (3) to five (5) years of experience, including:
Minimum of three (3) years of coding, insurance, or denial-related experience
Minimum of three (3) years of management experience
Supervision
Supervisory Responsibility: Yes
Number of Employees Supervised: 1-5
Age of Patients Served
If you want this aligned e