North Oaks Health System
Status: Full Time
Shift: 7-4:30
Exempt: Yes
Summary:
The Denial Manager assumes responsibility and accountability for managing hospital and professional claims denials for third party payers. This includes overseeing the denial process used by in-house staff and continually working to identify opportunities for workflow improvement. The Denial Manager serves as a liaison to revenue cycle staff, clinical departments, payers, and providers by ensuring effective communication between all parties.
Other information:
FACTORS RELATING TO THE JOB
A. Experience, Knowledge and Skill
Previous Experience and Education:
A Bachelor's degree in business, healthcare administration, or a related field is preferred. Minimum of 3 years of experience in a healthcare environment, particularly in healthcare billing, collections, payment processing or denial management. Supervisory experience of a minimum of 1 year.
Specialized or Technical Education Required:
Experience in integrating financial, clinical, and coding processes to improve compliance and maximize reimbursement.
Ability to take initiative by identifying problems, conceptualizing resolutions, and implementing change
Possess efficient time management skills and proven ability to multitask under deadlines.
Exceptional writing and communication skills
Demonstrates knowledge of:
o Hospital and professional billing processes and reimbursement o Medicare and Medicaid and appeals o Third party contracts o insurance protocols, delay tactics, systems, and workflows o Federal & State regulations related to denials and appeals Strong comfort level with computer systems.
Demonstrates excellent leadership, conflict-resolution, and customer service skills
Excellent skills in excel, Word and Power Point required.
Manual or Physical Skill Required:
Must have good visual acuity to determine quality of work, and good hearing acuity to answer phones. Must be able to file in both alpha and numeric systems. Physical Effort Required: Strength: Sedentary Push: Occasionally Pull: Occasionally Carry: Occasionally Lift: Occasionally Sit: Constant Stand: Occasionally Walk: Occasionally B. Work Complexities Complexity and Difficulty of Work: Must have good visual acuity to determine quality of work. Requires sufficient dexterity to operate a computer keyboard, telephone, copier, ten-key calculator and other office equipment; long hours of sitting and working on a computer; minimal telephone contact; occasional lifting of files and/or boxes; periodic walking between various departments. Seriousness of Errors: Inaccuracy could cause incorrect billing and delayed payments on accounts, adversely affecting the image, reputation and cash flow of North Oaks Health System C. Working Conditions Hazards: Minimal
Adverse Working Conditions:
Ability is needed to handle the stress associated with meeting deadlines and concentrate on specific details on the job despite distractions. D. Contacts Contacts with Customers, the General Public or Other Companies: Occasional personal contact with the general public or patients to resolve billing questions or Problems; occasional contact with doctor's offices; occasional contact with third party payers. Contacts with Other Departments: Regular contact with clinical departments to obtain billing information; frequent contact with Medical Records and admitting to assure accurate billing. E. Responsibilities: Responsibility for the safety of others: Keep office equipment and personal items in order to prevent injury to self and others. Adhere to all safety guidelines and remain familiar with policies and procedures of the same. Responsibility for Company Funds or Property Indirectly responsible for the incoming payments on patients accounts; responsible for the processing of adjustments to patients accounts Responsibility for Confidential Information:
Safeguard and preserve confidentiality at all times.
Responsibility for Performance of Work without immediate supervisor:
Responsibility for the Supervision of Others: None
Office hours are 8:00 a.m. – 4:30 p.m., Monday through Friday. However, when necessary, working hours will be scheduled according to department needs. Responsibilities: Supervise and evaluate work performed by the Denial Management Specialists. Ensure the timeliness and accuracy of identifying denials and submitting appeals.
Serve a Denial Coordinator and conduct monthly Denial meeting. Prepare and present monthly denial report. Perform monthly sampling and coordinate root cause analysis with departments and providers.
Responsible for coordinating and monitoring the denial management and appeals process.
Collaborate with physicians, case managers, revenue cycle personnel and payers to appeal denials.
Understand the claims processing system to determine various aspects of the claim detail which contribute to denial management.
Review EOBs as needed to determine/address payer disallowed charges.
Understand payer reimbursement guidelines and monitor payer policy changes.
Work collaboratively with EPIC team to ensure charging and billing integrity to prevent denials.
DESCRIPTION OF DUTIES continued: Track denial trends and reports to Revenue Cycle team to facilitate processes improvement in denial management.
Monitors staff productivity standards to ensure timely submit appeals to payers.
Direct and supervise the Reimbursement staff that are responsible for:
Cash Posting
Payment Variance Analysis
Expected Payment development
Refunds
Meet Health System denial targets.
Establish education and training programs to reduce denials.
Maintain professional affiliations and consistently strive to enhance professional growth and development.
Perform other duties as assigned by Manager of Director.
Follows North Oaks Health System's compliance programs and all federal and state regulatory guidelines.
Experience in integrating financial, clinical, and coding processes to improve compliance and maximize reimbursement.
Ability to take initiative by identifying problems, conceptualizing resolutions, and implementing change
Possess efficient time management skills and proven ability to multitask under deadlines.
Exceptional writing and communication skills
Demonstrates knowledge of:
o Hospital and professional billing processes and reimbursement o Medicare and Medicaid and appeals o Third party contracts o insurance protocols, delay tactics, systems, and workflows o Federal & State regulations related to denials and appeals Strong comfort level with computer systems.
Demonstrates excellent leadership, conflict-resolution, and customer service skills
Excellent skills in excel, Word and Power Point required.
Manual or Physical Skill Required:
Must have good visual acuity to determine quality of work, and good hearing acuity to answer phones. Must be able to file in both alpha and numeric systems. Physical Effort Required: Strength: Sedentary Push: Occasionally Pull: Occasionally Carry: Occasionally Lift: Occasionally Sit: Constant Stand: Occasionally Walk: Occasionally B. Work Complexities Complexity and Difficulty of Work: Must have good visual acuity to determine quality of work. Requires sufficient dexterity to operate a computer keyboard, telephone, copier, ten-key calculator and other office equipment; long hours of sitting and working on a computer; minimal telephone contact; occasional lifting of files and/or boxes; periodic walking between various departments. Seriousness of Errors: Inaccuracy could cause incorrect billing and delayed payments on accounts, adversely affecting the image, reputation and cash flow of North Oaks Health System C. Working Conditions Hazards: Minimal
Adverse Working Conditions:
Ability is needed to handle the stress associated with meeting deadlines and concentrate on specific details on the job despite distractions. D. Contacts Contacts with Customers, the General Public or Other Companies: Occasional personal contact with the general public or patients to resolve billing questions or Problems; occasional contact with doctor's offices; occasional contact with third party payers. Contacts with Other Departments: Regular contact with clinical departments to obtain billing information; frequent contact with Medical Records and admitting to assure accurate billing. E. Responsibilities: Responsibility for the safety of others: Keep office equipment and personal items in order to prevent injury to self and others. Adhere to all safety guidelines and remain familiar with policies and procedures of the same. Responsibility for Company Funds or Property Indirectly responsible for the incoming payments on patients accounts; responsible for the processing of adjustments to patients accounts Responsibility for Confidential Information:
Safeguard and preserve confidentiality at all times.
Responsibility for Performance of Work without immediate supervisor:
Responsibility for the Supervision of Others: None
Office hours are 8:00 a.m. – 4:30 p.m., Monday through Friday. However, when necessary, working hours will be scheduled according to department needs. Responsibilities: Supervise and evaluate work performed by the Denial Management Specialists. Ensure the timeliness and accuracy of identifying denials and submitting appeals.
Serve a Denial Coordinator and conduct monthly Denial meeting. Prepare and present monthly denial report. Perform monthly sampling and coordinate root cause analysis with departments and providers.
Responsible for coordinating and monitoring the denial management and appeals process.
Collaborate with physicians, case managers, revenue cycle personnel and payers to appeal denials.
Understand the claims processing system to determine various aspects of the claim detail which contribute to denial management.
Review EOBs as needed to determine/address payer disallowed charges.
Understand payer reimbursement guidelines and monitor payer policy changes.
Work collaboratively with EPIC team to ensure charging and billing integrity to prevent denials.
DESCRIPTION OF DUTIES continued: Track denial trends and reports to Revenue Cycle team to facilitate processes improvement in denial management.
Monitors staff productivity standards to ensure timely submit appeals to payers.
Direct and supervise the Reimbursement staff that are responsible for:
Cash Posting
Payment Variance Analysis
Expected Payment development
Refunds
Meet Health System denial targets.
Establish education and training programs to reduce denials.
Maintain professional affiliations and consistently strive to enhance professional growth and development.
Perform other duties as assigned by Manager of Director.
Follows North Oaks Health System's compliance programs and all federal and state regulatory guidelines.