Manager of Medical Denials

Richardson, Texas 75080

Post Date: 07/12/2018 Job ID: 35858 Industry: General

Manager of Denials, Medical Revenue Cycle Ops (PCON)

The Manager will be responsible for daily operations of follow up and denials team with emphasis on superior leadership, special projects and audits. The manager is passionate about the mechanics of successful and payer collections and seeks innovative solutions with their team to optimize performance. This individual will be highly skilled in the use and understanding of billing, follow up and payor systems; knowledgeable of payer rules and payer/provider workflows that result in optimal reimbursement; and have an innate interest in analytical research. The Manager has a good understanding managed care contracts and is responsible for appeals and contract variance workflow.

KEY RESPONSIBILITIES:
  • Maintain knowledge of payer rules, regulations and guidelines to ensure ethical and compliant standards and provide continued education for staff as appropriate.
  • Provide analysis and data driven recommendations to senior management.
  • Design and implement policies, procedures and systems to improve productivity, efficiency and customer service, as well as, enhance revenue acquisition.
  • Monitors daily workload of the follow up team to optimize load-balancing and staff acuity.
  • Demonstrate ability to set priorities and manage multiple projects simultaneously.
  • Develops and implements monitoring mechanisms to track edit productivity and quality, identifying and providing additional training where needed.
  • Demonstrates respect and regard for the dignity of all patients, families, visitors, and fellow employees to ensure a professional, responsible, and courteous environment.
  • Designs, establishes and maintains an organizational structure and staffing model to accomplish the organization's goals and objectives in an effective manner; recruits, trains, coaches and evaluates staff members.
  • Works to assure program compliance with all applicable federal and state rules, regulations and laws related to healthcare billing.
  • Conduct regular staff meetings to review productivity metrics, reaffirm weekly/monthly goals, provide coaching/training and ensure work is appropriately prioritized.
  • Demonstrate excellent communication skills, both written and verbal.

REQUIRED KNOWLEDGE & SKILLS:
  • Working knowledge of CPT-4, HCPCS, revenue codes and ICD-10 coding.
  • Proficient with Revenue Cycle Management software.
  • Strong written and oral communication skills.
  • Thorough working knowledge of all Microsoft Office programs.
  • Understanding of the organization's goals and objectives.
  • Self-motivated and directed.
  • Ability to effectively prioritize and execute tasks in a high-growth, fast paced environment.
  • Experience working in a team-oriented, collaborative environment.
  • Strong customer-service orientation.
  • Prior experience in Managed care contracting.

EDUCATION/EXPERIENCE/LICENSURE/TECHNICAL/OTHER:

Education:Bachelor’ s Degree in Health Information Management, Business or Health Administration preferred.

Experience:At least 3 years’ experience in AR management, medical practice revenue cycle, Third Party Payor work, or related health care field. Minimum of 2 years’ management experience.

Software/Hardware:Intermediate or Advanced knowledge of MS Excel & MS Word required.

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