Manager – Denials

Key Responsibilities:

• Serve as SME for Commercial and Government contracts and ensure team understands how to apply contract language
• Assist team with efficient review of hospital contracts to identify and collect cash payments from Commercial and Government insurance companies, ensuring prompt payments of delayed, denied and underpaid claims.
• Ensure the processes and inventory are in place to hit monthly, quarterly, and annual revenue expectations for the company. 
• Take the lead in explaining variances to management on a regular basis regarding bill filed, appeal filed, and revenue metrics.
• Responsible for hiring, staff training and oversight, including annual goal planning, annual reviews, monthly account reviews, job assignments for each staff member with at least weekly monitoring, meet with various staff weekly (based on project due dates) for discussion on project progress, road blocks, assistance on process and provide any tools and input needed.  Ability to direct and motivate staff.
• Measures and monitors key performance metrics and delivers concise performance reporting to stakeholders with corrective action plans for variances when appropriate.
• Assists in setting the strategic direction of the revenue services team and identifies areas of continuous improvement in conjunction with the leadership team.
• Assists in preparation and presentation of weekly, monthly, and quarterly client reporting.
• Maintain a current working knowledge of all related HIPAA regulations and ensures staff compliance to these requirements.  This includes updating work processes, system capabilities, and policies and procedures as well as training staff on these requirements.
• Maintain a strong knowledge of insurance billing and reimbursement procedures and regulations related to insurance billing and collections.
• Assist in the development and monitoring of quality and productivity metrics and benchmarks for the revenue services functions based on industry standards and internal benchmarks. 
• Authority to terminate staff as necessary to enable it to achieve the approved strategy.              
• Management of Revenue Services department.
• Ensures smooth operations and improves customer satisfaction.
• Assist team with assigned tasks.
• Assist in Mentoring Supervisors.
• Other duties as required.

Requirements and Qualifications:

• Bachelor’s Degree or CRCR Certification preferred.
• Knowledge of Commercial and Government contracts, specifically underpayment review. Billing expertise is a plus.
• Knowledge and understanding of financials, HMO’s, hospital revenue cycle process, ancillary and provider contract language and familiarity with healthcare and provider data sets and trend spotting.
• Intermediate understanding of ICD, HCPCS/CPT coding, and medical terminology.
• Above average analytical and critical thinking skills.
• Full understanding of hospital reimbursement, Intermediate knowledge of Managed Care contracts, Contract Language, and Federal and State requirements.
• Familiarity with HMO, PPO, IPA, and capitation terms and how these payors process claims.
• Ability to prioritize work and meet deadlines is required.
• 5-7 years’ experience in management or supervisory experience with teams of 12+.
• 5-7 years’ experience in healthcare setting, information technology company or managed care industry, preferably in the area of Finance/Collections, Business Operations or Revenue Recovery. 
• Experience working with internal teams while serving in a client facing or client support role.
• Must communicate effectively and professionally with solid attention to detail and verbal and written problem-solving. Specifically, strong telephone communication skills are required.
• Must have strong computer proficiency and understand how to use basic office applications, including MS Office (Word, Excel, and Outlook).
• Regular and predictable attendance.
• Equivalent combination of education and experience will be considered.
• To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.  Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions.

Special Considerations and Prerequisites:

• Strong and professional written and oral communications skills.
• Has worked in a production environment and can meet deadlines.  Provide examples of goals measurement for yourself and your team.
• Excellent people skills to interface with multiple internal stakeholders.
• Proven success in obtaining quantifiable results from and setting priorities for direct reports.  Describe how you manage to individual goals. 
• Organized and can handle multiple projects simultaneously.
• Health care experience and familiarity with payers, contracts, and provider data sets.
• Experience communicating obstacles & challenges and developing action plans to present to management.