Manager, Denials and Appeals

Oversee the functionality, work flow, and day-to-day activity of the Denial Prevention Unit and Inpatient Appeals department and associated benchmarks and goals. Provide strategic direction to facilitate the maximization of revenue and assists Director with other associated revenue activities. Develop and maintain departmental productivity and quality reports.

What You Will Do

• Establishes service goals to be achieved, adjusting as needed and manages work quality and productivity.
• Identifies problem areas and develops plan of action to ensure benchmark standards are obtained and maintained.Responsible for all hiring and related personnel decisions, completing routine performance review evaluations, leading employee engagement initiatives, training, scheduling, staff meetings, and staff concerns are resolved.Meets regularly with Supervisor to ensure productivity and accuracy and to ensure consistency in quality and quantity while meeting departmental goals. Reports any discrepancies or issues to Director.Oversees the distribution of work assignments among staff and assists in determining work priorities.Encourages employee participation in process improvement by listing and giving feedback with respect to departmental needs
• Monitors denial trends for issues and work with internal departments and medical offices to offer solutions and assist in meeting revenue benchmarks.
• Collaborate with Physician Advisors for clinician education (including but not limited to Think in Ink), UM Nurse and Appeals Nurse education, Peer to Peer reviews and discussion with Payer Medical Directors for Payer Policy changes.
• Work with managed care contracting with regards to payer process changes and trends.Work with operational leaders for process improvement opportunities.Develop denial prevention strategies to decrease denial work and prevent decreased reimbursement.
• Ensures efficient appeals process for accurate and timely reimbursement.
• Assists in the development of new procedures that focus on improvement in quality and quantity of work performed. Offers and implements suggestions to increase work flow as appropriate.
• Maintains strict confidentiality in regard to patient's personal, medical and financial information.Acts as a role model for professionalism through appropriate conduct and demeanor at all times.Manages operating expenses and FTE budget to meet department goals.Updates and creates new policies as needed in conjunction with Director.
• Maintains communication between RCM departments, Operational Leaders, UM, CCA and physician's and their office staff to resolve issues with providers, system issues and carrier issues.

Additional Responsibilities

• Performs other duties as assigned.
• Complies with all policies and standards.
• For specific duties and responsibilities, refer to documentation provided by the department during orientation.
• Must abide by all requirements to safely and securely maintain Protected Health Information (PHI) for our patients. Annual training, the UH Code of Conduct and UH policies and procedures are in place to address appropriate use of PHI in the workplace.