Rush University Medical Center
Mgr Middle Rev Cycle Denials Prevention & Appeals-22642
Rush University Medical Center, Chicago, Illinois, United States, 60290
Mgr Middle Rev Cycle Denials Prevention & Appeals
Location: Chicago, Illinois
Business Unit: Rush Medical Center
Hospital: Rush University Medical Center
Department: Revenue Cycle Revenue Integrit
Work Type: Full Time (FTE 0.9-1.0)
Shift: Shift 1
Work Schedule: 8 Hr (7:00 AM - 3:00 PM)
Pay Range: $41.44 - $67.44 per hour
Rush offers exceptional rewards and benefits learn more at our Rush benefits page ( https://www.rush.edu/rush-careers/employee-benefits )
Summary The system manager of denials prevention and appeals, working in a remote environment, will lead several teams promoting a positive culture of accuracy and appropriate reimbursement. This leader will identify root causes of denials, propose preventative measures with the use of Epic automation and ancillary coding software solutions. The manager will exemplify the Rush mission, vision and values and act in accordance with Rush policies and procedures.
Required Job Qualifications
Bachelor’s or Associate degree in health information technology, healthcare management, nursing, finance, or other related fields or 10 years of industry experience in lieu of a degree
AHIMA or AAPC Certification (such as CCS, CCA, CPC, COC, CPMA, RHIT or RHIA)
Five years of supervisory experience
Five years of experience denials management in hospital (HB) or professional (PB) Epic work queues, along with ICD-10/CPT/HCPCS codes, Modifiers, NCCI edits, and compliant coding methodologies
Experience with Epic reporting and dashboards
Demonstrated ability to communicate clearly and effectively
Proficient in Microsoft Office, Excel, PowerPoint, and Word skills
Strong interpersonal skills necessary for the communication and training of Revenue Integrity concepts
Ability to perform multiple tasks with excellent time management skills
Preferred Job Qualifications
Epic Certified
Responsibilities
Oversee the Middle Revenue Cycle Audit and denials team members and appeals process, ensuring timely and accurate submission of appeals within payor timelines, and strict compliance with regulations, coding guidelines, and payer policies.
Collaborate cross-functionally to maximize reimbursement and support the middle revenue cycle prevention program that ensures timely and accurate submission of appeals and resolution of denied claims.
Identify denial root causes and instill mitigation solutions involving technology, training, and process solutions.
Act as a subject matter expert on insurance regulations, coverage, policies, payer contracts, and reimbursement guidelines while collaborating with other components of the revenue cycle.
Conduct comprehensive research and analytics on denial data, track issues, identify payor behavior trends, and coordinate efforts for denial prevention while developing detailed reports aimed at denial prevention.
Develop and implement comprehensive action plans that document identified solutions and facilitate accountability in efforts to prevent and reduce denials.
Build relationships within the revenue cycle, compliance, ancillary departments, clinical areas, vendors, and consultants of the organization that serve as mutually beneficial partnerships to ensure revenue cycle goals are achieved.
Keep abreast of changing industry and regulatory requirements and communicate changes to impacted leaders, staff, and provide training.
Identify and trouble-shoot coding, reimbursement, quality, or clinical documentation issues, collaborate with ancillary departments and Epic build team to resolve, maintain a record of issues, and communicate solutions and improvements.
Identify trends and lead performance improvement efforts through multi-disciplinary teams to streamline processes, enhance coding automation, train staff, and promote accuracy.
Responsible for implementing short and long-term plans and objectives within set deadlines to reduce denials and process audits and appeals within payor timelines.
Develop, update and implement job standards, job duties, job aids, departmental policies, and performance appraisals for all areas of responsibility. Engages in development and growth of self and the team.
Collect, interpret, and communicate performance data using various tools and systems, while also using this data to make decisions on how to achieve performance and budgetary goals.
Responsible for interviewing, hiring, orienting new team members (staff & temp), staffing, performance management and development of staff. Counsel and disciplines employees, when necessary, in accordance with department and/or organizational policies. Maintains staff schedules, timecards, and payroll with fiscal responsibility.
Facilitate a positive culture that exemplifies growth-minded practices, leadership, and industry-best practices.
Rush is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, and other legally protected characteristics.
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Business Unit: Rush Medical Center
Hospital: Rush University Medical Center
Department: Revenue Cycle Revenue Integrit
Work Type: Full Time (FTE 0.9-1.0)
Shift: Shift 1
Work Schedule: 8 Hr (7:00 AM - 3:00 PM)
Pay Range: $41.44 - $67.44 per hour
Rush offers exceptional rewards and benefits learn more at our Rush benefits page ( https://www.rush.edu/rush-careers/employee-benefits )
Summary The system manager of denials prevention and appeals, working in a remote environment, will lead several teams promoting a positive culture of accuracy and appropriate reimbursement. This leader will identify root causes of denials, propose preventative measures with the use of Epic automation and ancillary coding software solutions. The manager will exemplify the Rush mission, vision and values and act in accordance with Rush policies and procedures.
Required Job Qualifications
Bachelor’s or Associate degree in health information technology, healthcare management, nursing, finance, or other related fields or 10 years of industry experience in lieu of a degree
AHIMA or AAPC Certification (such as CCS, CCA, CPC, COC, CPMA, RHIT or RHIA)
Five years of supervisory experience
Five years of experience denials management in hospital (HB) or professional (PB) Epic work queues, along with ICD-10/CPT/HCPCS codes, Modifiers, NCCI edits, and compliant coding methodologies
Experience with Epic reporting and dashboards
Demonstrated ability to communicate clearly and effectively
Proficient in Microsoft Office, Excel, PowerPoint, and Word skills
Strong interpersonal skills necessary for the communication and training of Revenue Integrity concepts
Ability to perform multiple tasks with excellent time management skills
Preferred Job Qualifications
Epic Certified
Responsibilities
Oversee the Middle Revenue Cycle Audit and denials team members and appeals process, ensuring timely and accurate submission of appeals within payor timelines, and strict compliance with regulations, coding guidelines, and payer policies.
Collaborate cross-functionally to maximize reimbursement and support the middle revenue cycle prevention program that ensures timely and accurate submission of appeals and resolution of denied claims.
Identify denial root causes and instill mitigation solutions involving technology, training, and process solutions.
Act as a subject matter expert on insurance regulations, coverage, policies, payer contracts, and reimbursement guidelines while collaborating with other components of the revenue cycle.
Conduct comprehensive research and analytics on denial data, track issues, identify payor behavior trends, and coordinate efforts for denial prevention while developing detailed reports aimed at denial prevention.
Develop and implement comprehensive action plans that document identified solutions and facilitate accountability in efforts to prevent and reduce denials.
Build relationships within the revenue cycle, compliance, ancillary departments, clinical areas, vendors, and consultants of the organization that serve as mutually beneficial partnerships to ensure revenue cycle goals are achieved.
Keep abreast of changing industry and regulatory requirements and communicate changes to impacted leaders, staff, and provide training.
Identify and trouble-shoot coding, reimbursement, quality, or clinical documentation issues, collaborate with ancillary departments and Epic build team to resolve, maintain a record of issues, and communicate solutions and improvements.
Identify trends and lead performance improvement efforts through multi-disciplinary teams to streamline processes, enhance coding automation, train staff, and promote accuracy.
Responsible for implementing short and long-term plans and objectives within set deadlines to reduce denials and process audits and appeals within payor timelines.
Develop, update and implement job standards, job duties, job aids, departmental policies, and performance appraisals for all areas of responsibility. Engages in development and growth of self and the team.
Collect, interpret, and communicate performance data using various tools and systems, while also using this data to make decisions on how to achieve performance and budgetary goals.
Responsible for interviewing, hiring, orienting new team members (staff & temp), staffing, performance management and development of staff. Counsel and disciplines employees, when necessary, in accordance with department and/or organizational policies. Maintains staff schedules, timecards, and payroll with fiscal responsibility.
Facilitate a positive culture that exemplifies growth-minded practices, leadership, and industry-best practices.
Rush is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, and other legally protected characteristics.
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