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AdventHealth Executive Medical Director Denials Management in Altamonte Springs, Florida

Executive Medical Director

AdventHealth Corporate

Location Address: 2600 Lucien Way, Maitland, FL 32751

Top Reasons to Work at AdventHealth Corporate

  • Great benefits

  • Immediate Health Insurance Coverage

  • Career growth and advancement potential

Work Hours/Shift:

  • Full-Time, Monday – Friday

You Will Be Responsible For:

  • Providing physician review of post-remittance denials, writing and submitting clinical denial appeals when required

  • Performing peer-to-peer discussions with payer medical directors and/or discussing cases with payer representatives to facilitate claim resolution and build payer relationships

  • Utilizing clinical knowledge and experience, information science, data analysis, and interpersonal skills to support and represent the optimal denials recovery and prevention processes identified with all medical, clinical and ancillary departments

  • Researches and responds to denials in a timely fashion and identifies trends through data analysis

  • Responds to identified trends by recommending changes in practice and/or provider documentation to promote denial prevention initiatives

  • Serves as a subject matter expert, providing clinical expertise and business direction in support of best practice, world class denial management and prevention strategies

  • Adheres to AdventHealth Compliance Plan and to all rules and regulations of all applicable local, state and federal agencies and accrediting bodies.

What You Will Need:

  • Graduate from medical school and residency program

  • Five years recent clinical practice experience

  • Seven years of leadership experience

  • Current, valid state license as a physician

  • Board certified and eligible for membership on the Hospital medical staff

Job Summary:

The Denials Management Executive Medical Director is an integral member of the centralized denial management team who provides physician review of post remittance clinical denials and supports optimal denials recovery and prevention processes through their clinical knowledge and experience. The Denials Management Executive Medical Director educates, advises, and informs members of the Denial Management, Revenue Cycle, Managed Care, and applicable Medical Staff leaders of specific issues and prevention initiatives related to clinical denial management.

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.

We are an equal opportunity employer and do not tolerate discrimination based on race, color, creed, religion, national origin, sex, marital status, age or disability/handicap with respect to recruitment, selection, placement, promotion, wages, benefits and other terms and conditions of employment.

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