Denials Management Director Job Details
Cost and Reimbursement
Works collaboratively with physicians, staff and other health care professionals at all three acute care facilities to review, address and prevent denials – technical, medical necessity, and others.
Collaborates with all revenue cycle team members on daily case issues as well as developing system-wide quality improvement/performance improvement initiatives.
Identify denials trends and develop appropriate plans to reduce.
Provide leadership, guidance and support for all denials prevention.
Actively manage, maintain and communicate denial / appeal activity to appropriate stakeholders and report suspected or emerging trends related to payer denials to Revenue Cycle management.
Addresses denials issues with Utilization Management, Physician Advisor, CFO and Chief Medical Officer/Medical Director as appropriate.
Coordinates large dollar denials for follow-up.
Assist with the development and implementation of policies, procedures, standards and initiatives to reduce denials.
Work with revenue cycle denials team to identify denials issues and processes to correct using the denial software tool.
Actively participate in monthly revenue cycle denial meetings to help reduce overall denials.
Reports any trending and process improvement initiatives to CFO and key stakeholders
Collaborates in the ongoing re-design and re-engineering of Denial functions, to meet the changing needs and priorities of the organization.
Other duties as assigned
Minimum 3 years’ experience in leadership role
Must have excellent computer skills and ability to learn new systems
Must have strong organizational (time management) skills, strong interpersonal skills, the ability to handle multiple priorities with strong attention to detail.
Knowledge of and practical use of good business English, spelling, arithmetic, practices and the ability to communicate effectively using written and verbal skills.
Proficient in email communications and internet usage along with basic use of Microsoft Excel and Word.
Knowledge of information technology to evaluate care effectiveness (care process, outcomes and cost).
Ability to work autonomously within matrix environment without direct supervision or support.
Additional Information Requisition ID: 2019-R0251758
Schedule: Full-time Shift: Day Job
Market: CHI Memorial
About this company
Memorial Health Care System is a not-for-profit, faith-based healthcare organization dedicated to the healing ministry of the Church. Founded by the Sisters of Charity of Nazareth and strengthened as part of Catholic Health Initiatives, it offers a continuum of care including preventative, primary and acute hospital care, as well as cancer and cardiac care, orthopedic and rehabilitation services. Memorial is a regional referral center of choice with 4,000 associates and more than 700 affiliated physicians providing health care throughout Southeast Tennessee and North Georgia. Memorial Health Care System is recognized as one of the nation's 100 Top Hospitals® by Thomson Reuters, the health care industry's leading source of information on hospital quality.
Location/Region: Chattanooga, TN (37404)