ECU Health
Supervisor, Denials Management (PB)
ECU Health, Greenville, North Carolina, United States, 27834
Supervisor, Denials Management (PB)
ECU Health is a mission‑driven, 1,708‑bed academic health care system serving more than 1.4 million people in 29 eastern North Carolina counties.
Position Summary The Denials Management Supervisor will work collaboratively across all areas of revenue cycle management to analyze, track, measure, prevent and manage denials. The supervisor will research payment policies, review potential underpayments/overpayments on both facility and professional accounts, and work with payers directly to ensure reimbursements are aligned with negotiated contracts. The role involves close collaboration with the Manager/Director to provide staff oversight and assistance, ensuring timely and thorough appeal of all non‑clinical denials, accurate and compliant resolution of all government‑mandated audits, and design and implementation of procedures and systems to optimize efficiency.
Responsibilities
Monitors reports and workloads to ensure denials are addressed timely.
Works with the Manager to develop and monitor goals for the denials team.
Provides guidance and oversight to the denials team to reduce preventable denials.
Addresses complex denials promptly, identifying root causes and process improvements.
Acts as liaison to various departments to streamline processes.
Assesses processes, identifies gaps and implements efficient workflows.
Prepares and analyzes monthly variance reports for Revenue Cycle Leadership, identifying trends by payer.
Identifies payment errors and works with payors for reconsideration/reprocessing of claims.
Prioritizes workload to enhance bottom line results.
Researches, identifies and follows up on contract underpayments caused by misinterpretation.
Maintains a collaborative relationship across all revenue cycle management departments.
Analyzes denial trends and coordinates with leadership on issue resolution.
Performs audits to identify opportunities and trends, including remittance advices, write‑offs and adjustments.
Understands, develops, implements and analyzes KPIs for continuous improvement.
Maintains knowledge of payor policies to assure optimal reimbursement within compliance.
Participates in provider and third‑party vendor conference calls on billing/reimbursement issues and trends.
Recommends procedural and system changes to improve processes, operational quality and efficiency.
Develops and recognizes staff through coaching, training, appraisal and counseling.
Conducts weekly AR team meetings and individual 1:1 meetings.
Skill Set Requirement
Demonstrated knowledge of Epic HB and/or PB workflow process.
Working knowledge of payer reimbursement methodologies.
Excellent written and verbal communication skills.
Knowledge of government/non‑government payor practices including precertification, filing deadlines, claims processing and coverage issues.
Advanced level skills utilizing reporting data packages, including Excel.
Knowledge of managed care insurance, governmental health programs, HMOs and their impact on reimbursements.
Working knowledge of medical terminology.
Computer, analytical, reporting and organizational skills.
Knowledge of medical practice operations.
Advanced knowledge of claims management, HIPAA standards, CMS requirements, managed care, CPT, and HCPCS coding.
Knowledge of governmental legal and regulatory provisions related to claims resolution activities.
Skill in establishing and maintaining effective relationships with employees, patients, physicians, insurers and the public.
Hands‑on leadership ability to prioritize, plan and supervise hospital and professional claims follow‑up.
Minimum Requirements Required Education/Course(s)/Training
Associate degree or higher and/or 5+ years of experience in professional and hospital revenue cycle account receivable management including government payers.
2+ years in a related lead or supervisory role within a professional and hospital centralized healthcare environment.
3 years of experience in combined/comprehensive contract variance review/analysis.
Preferred Education
Bachelor's degree in healthcare administration or related field of study.
Graduate of a medical billing program.
Medical coding experience and/or certification.
Performance Expectations
Work independently and efficiently with little supervision.
Strong customer service and human relations abilities.
Effect collaborative alliances and promote teamwork.
Ensure a high level of customer satisfaction for employees, patients, visitors, faculty, referring physicians and stakeholders.
Use various computer applications, including EPIC.
Make sound judgments in demanding situations.
React to frequent changes in duties and volume of work.
Desire to teach and transfer knowledge to team members.
Identify, evaluate and solve problems and correct errors.
Build and maintain strong internal relationships while motivating team members through consultative skills.
Identify and implement process improvements to optimize revenue cycle performance.
Other Information
Remote role (based out of Greenville, NC).
Monday – Friday day shift: 8:00 a.m. – 5:00 p.m.
Great benefits.
ECU Health About ECU Health: ECU Health is a mission-driven, 1,708‑bed academic health care system serving more than 1.4 million people in 29 eastern North Carolina counties. The not‑for‑profit system is comprised of 13,000 team members, nine hospitals and a physician group that encompasses over 1,100 academic and community providers practicing in over 180 primary and specialty clinics located in more than 130 locations. The flagship ECU Health Medical Center, a Level I Trauma Center, and ECU Health Maynard Children’s Hospital serve as the primary teaching hospitals for the Brody School of Medicine at East Carolina University. ECU Health and the Brody School of Medicine share a combined academic mission to improve the health and well‑being of eastern North Carolina through patient care, education and research.
General Statement It is the goal of ECU Health and its entities to employ the most qualified individual who best matches the requirements for the vacant position. Offers of employment are subject to successful completion of all pre‑employment screenings. We value diversity and are proud to be an equal opportunity employer. Decisions of employment are made based on business needs, job requirements and applicant qualifications without regard to race, color, religion, gender, national origin, disability, veteran status, genetic information, family and medical leave, sexual orientation, gender identity or expression, or any other status protected by law. We prohibit retaliation against individuals who bring forth any complaint, orally or in writing, to the employer, or against any individuals who assist or participate in the investigation of any complaint.
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Position Summary The Denials Management Supervisor will work collaboratively across all areas of revenue cycle management to analyze, track, measure, prevent and manage denials. The supervisor will research payment policies, review potential underpayments/overpayments on both facility and professional accounts, and work with payers directly to ensure reimbursements are aligned with negotiated contracts. The role involves close collaboration with the Manager/Director to provide staff oversight and assistance, ensuring timely and thorough appeal of all non‑clinical denials, accurate and compliant resolution of all government‑mandated audits, and design and implementation of procedures and systems to optimize efficiency.
Responsibilities
Monitors reports and workloads to ensure denials are addressed timely.
Works with the Manager to develop and monitor goals for the denials team.
Provides guidance and oversight to the denials team to reduce preventable denials.
Addresses complex denials promptly, identifying root causes and process improvements.
Acts as liaison to various departments to streamline processes.
Assesses processes, identifies gaps and implements efficient workflows.
Prepares and analyzes monthly variance reports for Revenue Cycle Leadership, identifying trends by payer.
Identifies payment errors and works with payors for reconsideration/reprocessing of claims.
Prioritizes workload to enhance bottom line results.
Researches, identifies and follows up on contract underpayments caused by misinterpretation.
Maintains a collaborative relationship across all revenue cycle management departments.
Analyzes denial trends and coordinates with leadership on issue resolution.
Performs audits to identify opportunities and trends, including remittance advices, write‑offs and adjustments.
Understands, develops, implements and analyzes KPIs for continuous improvement.
Maintains knowledge of payor policies to assure optimal reimbursement within compliance.
Participates in provider and third‑party vendor conference calls on billing/reimbursement issues and trends.
Recommends procedural and system changes to improve processes, operational quality and efficiency.
Develops and recognizes staff through coaching, training, appraisal and counseling.
Conducts weekly AR team meetings and individual 1:1 meetings.
Skill Set Requirement
Demonstrated knowledge of Epic HB and/or PB workflow process.
Working knowledge of payer reimbursement methodologies.
Excellent written and verbal communication skills.
Knowledge of government/non‑government payor practices including precertification, filing deadlines, claims processing and coverage issues.
Advanced level skills utilizing reporting data packages, including Excel.
Knowledge of managed care insurance, governmental health programs, HMOs and their impact on reimbursements.
Working knowledge of medical terminology.
Computer, analytical, reporting and organizational skills.
Knowledge of medical practice operations.
Advanced knowledge of claims management, HIPAA standards, CMS requirements, managed care, CPT, and HCPCS coding.
Knowledge of governmental legal and regulatory provisions related to claims resolution activities.
Skill in establishing and maintaining effective relationships with employees, patients, physicians, insurers and the public.
Hands‑on leadership ability to prioritize, plan and supervise hospital and professional claims follow‑up.
Minimum Requirements Required Education/Course(s)/Training
Associate degree or higher and/or 5+ years of experience in professional and hospital revenue cycle account receivable management including government payers.
2+ years in a related lead or supervisory role within a professional and hospital centralized healthcare environment.
3 years of experience in combined/comprehensive contract variance review/analysis.
Preferred Education
Bachelor's degree in healthcare administration or related field of study.
Graduate of a medical billing program.
Medical coding experience and/or certification.
Performance Expectations
Work independently and efficiently with little supervision.
Strong customer service and human relations abilities.
Effect collaborative alliances and promote teamwork.
Ensure a high level of customer satisfaction for employees, patients, visitors, faculty, referring physicians and stakeholders.
Use various computer applications, including EPIC.
Make sound judgments in demanding situations.
React to frequent changes in duties and volume of work.
Desire to teach and transfer knowledge to team members.
Identify, evaluate and solve problems and correct errors.
Build and maintain strong internal relationships while motivating team members through consultative skills.
Identify and implement process improvements to optimize revenue cycle performance.
Other Information
Remote role (based out of Greenville, NC).
Monday – Friday day shift: 8:00 a.m. – 5:00 p.m.
Great benefits.
ECU Health About ECU Health: ECU Health is a mission-driven, 1,708‑bed academic health care system serving more than 1.4 million people in 29 eastern North Carolina counties. The not‑for‑profit system is comprised of 13,000 team members, nine hospitals and a physician group that encompasses over 1,100 academic and community providers practicing in over 180 primary and specialty clinics located in more than 130 locations. The flagship ECU Health Medical Center, a Level I Trauma Center, and ECU Health Maynard Children’s Hospital serve as the primary teaching hospitals for the Brody School of Medicine at East Carolina University. ECU Health and the Brody School of Medicine share a combined academic mission to improve the health and well‑being of eastern North Carolina through patient care, education and research.
General Statement It is the goal of ECU Health and its entities to employ the most qualified individual who best matches the requirements for the vacant position. Offers of employment are subject to successful completion of all pre‑employment screenings. We value diversity and are proud to be an equal opportunity employer. Decisions of employment are made based on business needs, job requirements and applicant qualifications without regard to race, color, religion, gender, national origin, disability, veteran status, genetic information, family and medical leave, sexual orientation, gender identity or expression, or any other status protected by law. We prohibit retaliation against individuals who bring forth any complaint, orally or in writing, to the employer, or against any individuals who assist or participate in the investigation of any complaint.
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