The Tucson Shared Service Center is seeking a Director of Denials & Appeals to oversee the Denials & Appeals department within a large multi-facility CBO.
As a part of the Senior Leadership team, this position directs the operations of the Denials & Appeals Department. The position has accountability for timely and accurate appeals submissions. This position is responsible for identifying areas within the revenue cycle where changes can be made to decrease recurring errors that affect claim submission, accelerate cash collections and reduce in A/R days. Identify root causes for delays in processing and provide feedback to the appropriate personnel or department. Responsible for monitoring, training, and evaluating staff, resolving patient issues, overseeing vendors, assisting in the appeals of accounts, and working with the other areas within the business office.
ESSENTIAL JOB FUNCTIONS:
- Work with the leadership in other departments at each facility to analyze and recommend change regarding issues related to non-payment of claims
- Ensure that all denials and appeals are processed in accordance with Federal, State and NCQA time frames and othercontractual legal requirements
- Identify trends within denials and appeals and provide results to internal committees, CMS and the State as required by contract
- Serve as the point of contact for any issues or questions related to denials and appeals for various external agencies, including state, local and federal governments, local community and the public
- Integrate federal and state law changes to denials and appeals into company's regulatory system
- Develop strategic solutions and ensure issues are corrected and corrective measures are implemented to prevent recurrence
- Monitor & reportassociate benchmarks and performance monthly to provide incentive or perform disciplinary action as required
- Evaluates and implement processes to ensure alignment with company goals
- Ensures that all internal and external audit indicators are met
- Timely and consistently reports project status to upper management/leadership
- Development of staff, plans and goals
- Performs other duties as assigned
Bachelor'sDegree in business administration, business management, or closely related field. Additionalexperience may substitute for therequired education on one-for-oneyear basis.
BA/BSDegree or higher in business, accounting orfinancepreferred;experience in lieu ofdegree Eight (8)years of relativeexperience in hospital revenue cycle, inclusive of denials/appealsexperienceMinimum fiveyears supervisory or managementexperiencerequiredRN licensure highlypreferred.
- Administrative Skills:
Excellent interpersonal skills required to communicate with direct staff and internal/external customersMust possess excellent time management and organizational skillsDemonstrated critical thinking, creativity, problem solving and decision-making skillsCreate reports and/or presentations in Excel, Power Point or Word accurately and efficientlyMust be able to handle multiple tasks simultaneously and concentrate in a busy environment