Manager Denials Management

Our promise to you:

Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.

All the benefits and perks you need for you and your family:

• Benefits from Day One: Medical, Dental, Vision Insurance, Life Insurance, Disability Insurance

• Paid Time Off from Day One

• 403-B Retirement Plan

• 4 Weeks 100% Paid Parental Leave

• Career Development

• Whole Person Well-being Resources

• Mental Health Resources and Support

• Pet Benefits

Schedule:

Full time

Shift:

Day (United States of America)

Address:

900 HOPE WAY

City:

ALTAMONTE SPRINGS

State:

Florida

Postal Code:

32714

Job Description:

Directs audits and manages denials to minimize errors, rejections, and avoidable denials. Ensures follow-up and denial management activities align with standards, policies, guidelines, training, and practices. Analyzes data to identify root causes of denials and implements process improvements to prevent repeated errors. Collaborates with Revenue Cycle stakeholders to facilitate data sharing and maximize claims reimbursement. Monitors and reviews team performance for timeliness, productivity, and quality standards. Sets annual departmental goals and provides direction based on organizational standards. Resolves problems, including HR issues, and allocates resources effectively. Staffs, trains, and mentors team members to ensure high performance. Maintains and updates procedures to align with best practices and regulatory requirements. Approves staffing realignment and performance appraisals based on supervisors’ and director’s recommendations. Ensures timely, accurate, and comprehensive documentation of all claim activities. Serves as a liaison between multiple Revenue Cycle Departments, including Consumer Access, Patient Financial Services, Managed Care, and Revenue Integrity. Other duties as assigned.

Knowledge, Skills, and Abilities:

• Analyze, track, trend and escalate issues as needed in order to facilitate optimal revenue recovery [Required]
• Ingenuity and judgment are required to review facts, plan work, estimate costs, interpret results, draw conclusions, and take or recommend action [Required]
• Self-starter with the ability to work under limited day-to-day oversight [Required]
• Strong supervisor/management skills, providing clear performance expectations as well as evaluating/resolving performance problems. [Required]
• Time management proficient [Required]
• Critical thinking and analytical skills [Required]
• Proactive [Required]
• Results driven [Required]
• Strong attention to detail [Required]
• Ability to work in a project-oriented environment with people of various background [Required]
• Ability to work in a fast-paced dynamic environment and meet deadlines [Required]
• Comfortable providing group presentations [Required]
• Strong understanding of payer reimbursement and denial functions related to all payers including but not limited to Managed Care/Commercial, Managed Medicare, Medicaid, Medicaid HMO products and Government (i.e. VA and Tricare), [Required]
• Understanding of the application and interpretation of contract language and rates. [Required]
• Uses discretion when discussing personnel/patient related issues that are confidential in nature [Required]
• Effective oral and written communication skills, with the ability to articulate complex information to all levels of colleagues [Required]
• Proficiency in Microsoft Suite applications, specifically Excel, Word, and PowerPoint applications, as well as Outlook [Required]
• Strong organizational skills [Required]
• Strong keyboard and 10 key skills [Required]
• Proficiency with medical billing and remittance forms and processes, including 835 and 837 files, and UB04 and CMS-1500 (HCFA) forms [Preferred]
• Understanding of PFS registration and billing processes [Preferred]

Education:

• Bachelor's Degree [Required]
• Master’s Degree [Preferred]

Field of Study:

• Bachelor’s Degree in Business, Healthcare or Health Services Administration, Health Information Management, Communications, Finance, Accounting, Public Administration, Human Resources, Management, or Marketing
• Master’s Degree in Health Management, Business Administration, Finance, or other related area

Work Experience:

• 3+ years of experience in hospital denial management experience in a large, integrated healthcare delivery system [Required]
• 3+ years of experience in a supervisory/managerial position in a similar-sized healthcare organization [Required]
• Understanding of PFS registration and billing processes [Preferred]

Additional Information:

• An equivalent combination of education and relevant work experience may be considered in lieu of the stated degree requirement:
• Bachelor’s degree OR 4+ years of related work experience in a hospital-based revenue cycle department or related area (registration, finance, collections, customer service, medical office/physician, or contract management)

Licenses and Certifications:

• Certified Healthcare Financial Professional (CHFP) [Preferred]
• Certified Patient Access Management (CPAM) [Preferred]
• Certified Revenue Cycle Rep (CRCR) [Preferred]
• Fellow of the Healthcare Financial Management Association (FHFMA) [Preferred]

Physical Requirements: (Please click the link below to view work requirements)

• Physical Requirements – https://tinyurl.com/23km2677

Pay Range:

$84,531.20 – $157,248.00

Background Screening Requirement (Florida Law)

Certain positions are subject to Florida Level 2 background screening, including fingerprinting, as required by state law.

Applicants may review general information about Florida’s background screening requirements at the Florida Care Provider Background Screening Clearinghouse:
https://info.flclearinghouse.com/

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.