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ECU Health · 6 hours ago

Supervisor, Denials Management (PB)

United States

Full-time

Remote

Mid, Senior Level

5+ years exp

ECU Health is a mission-driven academic health care system serving over 1.4 million people in eastern North Carolina. The Denials Management Supervisor will collaborate across revenue cycle management to analyze and manage denials, ensuring compliance and optimizing efficiency.

Hospital & Health Care

Responsibilities

Monitors reports and workloads ensuring that denials are addressed timely

Works with the Manager, to develop and monitor goals for the denials team

Provides guidance and oversight to denials team to ensure the steady reduction of preventable denials contributing to the reductions of account receivable days

Contributes to the steady reduction of denials by addressing complex denials timely, as well as identifying root causes and process improvements to prevent future denials

Acts as a liaison to various departments to streamline processes

Assesses processes, identifies gaps and implements efficient workflows

Prepares and analyzes monthly variance reports to present to Revenue Cycle Leadership that identifies trends by payer of payment variances

Identify payment errors and work with the payors for reconsideration/reprocessing of claims

Prioritizes workload concentrating on priority work which will enhance bottom line results and achievement of the most important objectives

Researches, identifies, and follows up on contract underpayments resulting from contract misinterpretation

In conjunction with Manager, maintains a collaborative relationship across all revenue cycle management departments

Analyzes trends in denials and coordinates with the other revenue cycle management leaders on managing and resolving issues

Performs audits to identify opportunities and trends. Audits to include, but not limited to Remittance Advices, write off and adjustments

Understands, develops, implements, and analyzes key performance measures for continuous improvement. Identifies specific trends or issues and communicates status and resolution with leadership

Maintain continual knowledge of payor policies to assure optimal reimbursement for all services performed within the system, in compliance with government and third-party payor regulations

Participate in provider and third-party vendor conference calls regarding billing/reimbursement issues and trends, as well as Contract Interpretation and Joint Operating Committee meetings

Recommends procedural and system changes to improve processes, operational quality and efficiency, i.e., job aides, training resources, and workflow; actively participates in process improvement projects

Develops and recognizes staff through coaching, planning, training, appraising, and counseling employees

Conduct weekly AR team meetings and 1:1 meeting

Qualification

Epic HB/PB workflowPayer reimbursement methodologiesClaims managementMedical coding certificationGovernment payor practicesAdvanced Excel skillsAnalytical skillsMedical terminologyCustomer service skillsCommunicationOrganizational skillsTeam leadership

Required

Associate degree or higher and/or 5+ years of experience in professional and hospital revenue cycle account receivable management including government payers is required

2+ years in a related lead or supervisory role within professional and hospital centralized healthcare environment

3 years of experience in combined/comprehensive contract variance review/analysis

Working knowledge of payer reimbursement methodologies

Excellent communication skills, both written and verbal that present clear and concise information to a diverse audience

Knowledge of government/non-government payor practices including precertification, filing deadlines, claims processing, coverage issues and other requirements

Advanced level skills utilizing reporting data packages, including Excel

Knowledge of managed care insurance, governmental health programs, HMOs, and their impact on professional, hospital and post hospital care reimbursement

Working knowledge of medical terminology

Computer, analytical, reporting and organizational skills

Must have knowledge of medical practice operations

Advanced knowledge of claims management, HIPAA standards, CMS requirements, managed care, CPT, and HCPS coding

Governmental legal and regulatory provisions related to claims resolution activities

Skill in establishing and maintaining effective working relationships with other employees, patients, physicians, insurance organizations, and the public

Requires a hands-on leader with the ability to prioritize, plan, and supervise Hospital, and Professional Claims Follow-up Department