System Director Denials Mgmt-Payer Performance

CommonSpirit Health • $150K — $180K *

Chicago, IL 60629In-Person

Hospitals & Medical Centers

5 - 7 years of experience

Today

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Job Overview by Ladders

Qualifications

Doctor of Medicine or Doctor of Osteopathy degree from an accredited institution
7 years of experience in healthcare delivery systems, with a focus on physician advisory roles
5 years of leadership experience at a director level or equivalent
2 years collaborating with Revenue Cycle teams in a health system
2 years of experience in government, managed care, and commercial appeals
Previous role as Physician Advisor or in Care Management

Responsibilities

Provide strategic direction and leadership for payer performance and revenue reconciliation teams
Identify and resolve root causes of clinical claim denials and related financial issues
Develop strategies to prevent future claim denials and underpayments
Implement solutions to minimize write-offs and enhance cash flow
Create reports and dashboards tracking denial trends and financial impacts
Streamline workflows for managing and resolving denied claims
Collaborate across departments to execute comprehensive denials prevention strategies
Monitor healthcare policies and reimbursement models for best practices

Benefits

Remote work flexibility
Leadership role within a key healthcare function
Opportunity to implement process innovations
Collaboration with interdisciplinary teams
Impact on organizational financial health and efficiency

Full Job Description

Job Summary and Responsibilities

This is a remote position

The System Director of Denials Management-Payer Performance and Revenue Reconciliation is a key member of the healthcare organization's leadership team charged with meeting the organization's goals and objectives for assuring the effective, efficient utilization of health care services. This role should be an expert on matters regarding physician practice patterns, over and under-utilization of resources, medical necessity, levels of care, care progression, compliance with governmental and private payer regulations, and appropriate physician coding and documentation requirements. Under direction of the System Vice President of Utilization Management, this role will have responsibility and accountability for creating, implementing, and managing an integrated system-wide pre-and post-claim program for monitoring and assessing payer performance regarding clinical denials, appeals, and payments. This role will implement process innovations and work closely with insurance payers, revenue cycle, and national and region team leaders in revenue-producing areas to reduce inappropriate denials, ensure appropriate payment for services provided, and secure financial well being for the organization. This role will require communicating directly with national and region team leaders and externally with third party payers. This role is accountable for standardizing policies, practices, workflow, and data reporting as it relates to system wide denials.

Essential Functions

Provides overall strategic direction and leadership for the payer performance and revenue reconciliation team(s).
Identifies and addresses root causes of clinical claim denials, underpaid accounts, and unpaid accounts.
Develops and implements effective strategies to prevent future denial occurrences and/or claim underpayments.
Minimizes unnecessary write offs and avoidable losses through targeted solutions enhancing organization cash flow.
Develops reports and dashboards accurately reflecting denial trends and financial impact.
Implements enhanced workflows and procedures to streamline denials management and resolution of denied claims.
Collaborates with Utilization Management, Revenue Cycle, and Payer Strategy to implement comprehensive denials prevention and management strategies across departments; and payers.
Monitors healthcare policies, reimbursement models, and industry best practices related to utilization management and denials management for internalization, where appropriate.
Implements long-range strategic plans, goals and objectives for clinical denials management and claim reimbursement. Manages assigned budget and assists with the annual budget development process. Prepares cost estimates and budget recommendations. Monitors and controls expenditures.

Job Requirements

Education and Experience

Doctor Of Medicine or Doctor Of Osteopathy from an accredited medical school.
7 years of experience working with health care delivery systems including significant experience in physician advisory.
Minimum 5 years of leadership experience in a director level, or equivalent leadership role.
Minimum 2 years of experience working within or in collaboration with Revenue Cycle for a health system.
Minimum 2 years of experience performing government, managed care, and commercial appeals.
Previous Physician Advisor/Care Management or equivalent experience.

Where You'll Work

About CommonSpirit Health

CommonSpirit is a nonprofit health care center. They offer community health programs, research programs, virtual care services, and home health programs that address the root causes of poor health, such as access to care, affordable housing, neighborhoods, and a healthy environment.

CommonSpirit Health Careers

Join the dedicated team at CommonSpirit Health, a leader in healthcare innovation and community wellness. CommonSpirit Health offers a range of job opportunities that empower professionals to grow their careers in a supportive and diverse environment.

Explore Career Opportunities

CommonSpirit Health is actively hiring and offers a variety of positions that cater to different skills and career aspirations. From clinical roles to administrative positions, the company provides a platform for growth and professional development.

Experience a Culture of Care and Innovation

At CommonSpirit Health, the culture is grounded in diversity, leadership, and innovation. The team is committed to fostering an inclusive environment where every member’s contribution is valued. CommonSpirit Health leads with a spirit of compassion and a commitment to excellence in healthcare.

Join a Team That Values Diversity and Leadership

CommonSpirit Health believes in the power of diversity and leadership to drive innovation. The company invests in diversity training and leadership development programs, ensuring that all team members are equipped to lead with integrity and empathy.

Internship and Employment Opportunities

For those starting their career, CommonSpirit Health offers internship programs that provide hands-on experience in the healthcare industry. These internships are designed to develop essential skills and offer insights into various aspects of healthcare operations.

Benefits and Growth

Employees at CommonSpirit Health enjoy a comprehensive benefits package that supports both their professional and personal lives. The company is committed to the career growth of its employees, offering numerous opportunities for advancement and professional development.

Networking and Professional Development

CommonSpirit Health encourages networking and continuous learning. Employees have access to a wide range of professional development courses and are encouraged to connect with peers and leaders within the industry to enhance their career prospects.

Applying for a Position

To apply for a position at CommonSpirit Health, candidates should prepare their resume to highlight relevant experience and skills. The hiring process may include an interview to assess compatibility with the company’s values and culture. Interested candidates can explore job listings and submit applications through the CommonSpirit Health Careers portal.

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Size

10,001 employees

Industry