Schedule: Full time
Shift: Day (United States of America)
Address: 2600 LUCIEN WAY
City: MAITLAND
State: Florida
Postal Code: 32751
Job Description: - Provides strategic leadership for denial management operations across the system
- Develops and implements policies, procedures, and performance standards for denial investigation and appeals
- Oversees denial trend analysis and implements prevention strategies
- Manages payer relationships and escalates complex denial issues as appropriate
- Ensures compliance with all regulatory requirements and accreditation standards
- Develops and monitors key performance indicators for denial management
- Leads, mentors, and develops denial management staff across multiple teams
- Collaborates with revenue cycle leadership on strategic initiatives and process improvements
- Prepares and presents reports on denial performance to executive leadership
- Manages departmental budget and resource allocation
- Partners with IT and analytics teams to optimize denial management systems and reporting
- Performs other duties as assigned
Knowledge, Skills, and Abilities: - Comprehensive understanding of revenue cycle processes including charge capture, billing, and reimbursement [Required]
- Extensive knowledge of CPT, HCPCS, ICD coding systems, and billing regulations for government and commercial payers [Required]
- Expert knowledge of payer policies, denial processes, and appeal strategies [Required]
- Strong leadership skills with ability to develop and manage high-performing teams [Required]
- Excellent analytical skills with ability to interpret complex data and drive strategic decisions [Required]
- Strong written and verbal communication skills with ability to present to executive leadership [Required]
- Proficiency in Microsoft Suite applications and healthcare information systems [Required]
- Ability to build collaborative relationships across organizational boundaries [Required]
- Knowledge of healthcare compliance and regulatory requirements [Required]
- Proficiency with Epic EHR system [Preferred]
- Experience with Six Sigma, Lean, or other process improvement methodologies [Preferred]
- Experience with payer contract negotiations related to denials [Preferred]
- Experience with denial management technology platforms and analytics tools [Preferred]
Education: - Bachelor's [Required]
- Master's [Preferred]
Field of Study: - in finance, accounting or healthcare administrative field
Work Experience: - 5+ years of progressive leadership experience in healthcare revenue cycle operations, patient financial services, patient access management, or related healthcare financial operations [Required]
- 8+ years of progressive leadership experience in healthcare receivables, patient financial services, or revenue cycle operations within a complex healthcare environment. [Preferred]
Additional Information: - An equivalent combination of education and relevant work experience may be considered in lieu of the stated degree requirement:
- Bachelor's Degree AND 5+ years of related work experience [Required] OR
- Associate's Degree AND 7+ years of related work experience [Required] OR
- 9+ years of related work experience [Required]
Licenses and Certifications: - Healthcare Financial Management Association (HFMA) [Preferred]
- Certified Revenue Cycle Rep (CRCR) [Preferred]
Physical Requirements: (Please click the link below to view work requirements)
Physical Requirements - https://tinyurl.com/23km2677
Pay Range:$110,702.15 - $205,911.28
