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Denials Manager

Ensemble Health Partners Richmond, VA Full-Time
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The Denial Avoidance Manager provides oversight of all activities related to the monitoring, tracking and reporting of clinical and technical denials received for all acute facilities and trends activities related to write-offs and first-pass denials to coordinate with the hospitals, revenue cycle, and managed care to reduce those denials through process improvement and education. The Manager oversees a team of analysts and liaisons that produce and trend this data while coordinating the actionable items with the facilities.

Job Summary:

  • The Denial Avoidance Manager provides oversight of all activities related to the monitoring, tracking and reporting of clinical and technical denials received for all acute facilities and trends activities related to write-offs and first-pass denials to coordinate with the hospitals, revenue cycle, and managed care to reduce those denials through process improvement and education.
  • The Manager oversees a team of analysts and liaisons that produce and trend this data while coordinating the actionable items with the facilities.
  • Performs ongoing process improvement of daily activities related to denials functions to ensure processes are performed efficiently and effectively.
  • Generates reports to analyze trends in first-pass and write-off denial activity and works with appropriate departments to resolve recurring issues and correct underlying root causes for errors.
  • Provides relevant guidance and works to Resolve issues escalated by Avoidance Supervisors, Revenue Cycle Site Directors, and other participants related to denial avoidance.
  • Responsible for interviewing, hiring, staffing, training, performance management and development of staff. 
  • Counsels and disciplines employees when necessary in accordance with department and/or organizational policies. 
  • Develops, updates and implements job standards, job duties, departmental policies and performance appraisals for all areas of responsibility.
  • Regularly schedules and attends (through travel when possible)/leads meetings with Market and facility customers through the Denial Avoidance Committee meetings - including Finance Leadership, Revenue Cycle, Managed Care, and hospital ancillary department heads.
  • Documents and trends avoidance-related findings into defined templates or create reports or summaries as needed.
  • Performs reviews using all patient accounting, Host, Epic and related systems used across the ministry and summarizes trends concisely and actionably.
  • Assists in strategic planning and establishes departmental goals to optimize performance and meet budgetary goals while improving operations to increase customer satisfaction and meet the financial goals of the organization.
  • Creates materials and trains denial avoidance staff, facility revenue site directors, committee facilitators and members, and revenue cycle staff as necessary on denials-related trends and issues impacting the Ministry.
  • Performs other duties as assigned.

Requirements:

  • Minimum: 2 Year Associates Degree - Business, Finance, Nursing, Healthcare Admin or related
  • Preferred: 4 Year Bachelors Degree - Business, Finance, Nursing, Healthcare Admin or related
  • Combination of post- secondary education and experience will be considered in lieu of degree.
  • CRCR upon hire

Skills:

  • Proficient knowledge of Medicare, Medicaid and other third-party payer documentation, coding and billing regulations
  • Strong written and verbal communication skills in order to communicate in clear, concise terms to management at all levels and the ability to articulate complex regulatory information in layman's terms.
  • Detailed knowledge of healthcare coding and auditing in terms of theories and practices to serve as the resource for the clinical specialists on the team.
  • Experience with Epic
  • Experience with Athena, Cerner, IDX, GE Centricity, ECW a plus

Skills required

Revenues
Forecasting
Budgeting
Business Administration
Sales Tax
Accounting
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From a provider's standpoint, it's an age-old challenge: working with vendors and consultants who have good intentions, but are focused on a singular task or function within the revenue cycle and don't always have the experience or alignment with the provider to ensure that the upstream root cause is identified and corrected along with understanding the impact on the entire revenue cycle. In many cases, vendors are incentivized to correct issues in retrospect, not to help identify and hardwire a solution that prevents further downstream issues.

After years of working on the hospital and physician operations side and seeing great opportunity within revenue cycle to align the efforts of vendors and consultants with the long terms success of the organization, we set out to create a better way. We built a team of experienced hospital and physician revenue cycle leaders who not only understand in detail each segment of the revenue cycle but who have also personally been on the frontlines in helping solve many of the challenges in revenue cycle. Our partners and consultants have the unique ability to build relationships and connections with our clients because their backgrounds are similar and their interests are aligned. We believe that our people are our greatest asset and therefore take great care in selecting our team members.

Experience and passion for what we do and our approach toward partnership is what sets us apart. Since we've been on the provider side, our ability to analyze, develop strategy and execute on that strategy from a real-world point of view drives sustainable, long-lasting results that we can all be proud of.

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