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MO-REMOTE

Worker Type:

Regular

Job Summary:

Manages, coordinates, and supervises the day-to-day denial activities within the Hospital or Medical Group revenue cycle. The scope of responsibility is all post-billed denials (inclusive of clinical denials). Supervise a team of denials analyst responsible for determining root causes and preventing denials. Works cross-departmentally within and external to the Revenue Cycle function to identify trends and partner with key stakeholders to remedy and prevent revenue loss associated to denials.

Job Responsibilities and Requirements:

PRIMARY RESPONSIBILITIES

• Manages all team activities, including staffing, recruitment, hiring, onboarding, training, performance management, employee engagement and conflict management.

• Monitors final adjustments on completed denial accounts (either paid or final denied), and review documentation in appropriate system(s).

• Review and track trends of the causes for denials and recommendations for resolutions of the issues and findings from colleagues, and report findings to the Denials Director and others as needed.

• Monitor communication and follow-up processes related denials to ensure such activities are submitted timely, tracked, trended and reported to key stakeholders.

• Prepares service level metrics and interpretations for the Denials Director and RCO leadership.

• Participate in the redesign of Denial Management processes and systems to improve service, data integrity, and staff productivity/quality to achieve departmental goals and process outcomes.

• Assist with the identification of training needs and coordinate with the department training to develop and conduct training programs, including on-the-job training.

• Maintains a working knowledge of applicable Federal, State, and local laws and regulations, Integrity and Compliance Program and Code of Conduct, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical, and professional behavior.

• Performs other duties as assigned.

EDUCATION

• Bachelor’s degree in business or healthcare administration or a related field or equivalent combination of experience and education.

EXPERIENCE

• Five years' experience, with two years in leadership

PHYSICAL REQUIREMENTS

• Frequent lifting/carrying and pushing/pulling objects weighing 0-25 lbs.

• Frequent sitting, standing, walking, reaching and repetitive foot/leg and hand/arm movements.

• Frequent use of vision and depth perception for distances near (20 inches or less) and far (20 feet or more) and to identify and distinguish colors.

• Frequent use of hearing and speech to share information through oral communication. Ability to hear alarms, malfunctioning machinery, etc.

• Frequent keyboard use/data entry.

• Occasional bending, stooping, kneeling, squatting, twisting and gripping.

• Occasional lifting/carrying and pushing/pulling objects weighing 25-50 lbs.

• Rare climbing.

Work Shift:

Day Shift (United States of America)

Job Type:

Employee

Department:

8701000033 Patient Business Services

Scheduled Weekly Hours:

40

SSM Health is an equal opportunity employer. SSM Health does not discriminate on the basis of race, color, religion, national origin, age, disability, sex, sexual orientation, gender identity, pregnancy, veteran status , or any other characteristic protected by applicable law. Click here to learn more. (https://www.ssmhealth.com/privacy-notices-terms-of-use/non-discrimination?_ga=2.205881493.704955970.1667719643-240470506.1667719643)