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UC Davis Health · 23 hours ago

Enterprise Denials Program Manager

Sacramento, CA

Full-time

Hybrid

Senior Level

$9,283.33/mo - $19,150/mo

UC Davis Health is seeking an Enterprise Denials Program Manager to enhance their denials management process. This role involves owning payor-specific denial root cause analysis, improving workflows, and collaborating with various departments to maximize revenue and increase efficiency within the healthcare revenue cycle.

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Comp. & Benefits

Responsibilities

Enhance the current denials management process to reduce denials

Own payor-specific denial root cause analysis and workflow improvement response

Work with internal and external departments to formulate strategies, administer policies, processes, and resources

Ensure account information contains accurate and comprehensive data to provide timely billing and optimal reimbursement for services

Impact processes to include authorization, registration, charge capture, coding, insurance identification, data entry, billing, contract management, payment posting, refund processing, and collections

Provide expert analysis and reporting of contract payer performance to include payment trends, denials, delinquencies, and payment variances from expected reimbursement

Identify and track issues related to denials for feedback to Denial Management to maximize revenue and increase efficiency

Conduct analysis, system/process development, problem resolution, and workflow oversight

Serve as a backup for the department manager for operations and technical issues

Qualification

Revenue cycle operationsDenial managementEpic Reporting WorkbenchHealthcare billingData analysisContract managementHealthcare complianceMedical codingTeam managementLeadership skillsProblem-solving skillsCommunication skillsOrganizational skillsInterpersonal skills

Required

Bachelor's Degree in Business, Healthcare Administration, Health Information Management, or related field or equivalent combination of education and experience within a healthcare facility

Extensive experience in revenue cycle operations, denial management, payer policy, or related healthcare domains

Extensive experience in supervising and managing the daily activities of a team, ensuring efficient workflows, effective reporting, and comprehensive analytics

Experience recruiting, training, and mentoring denial analyst(s), ensuring they have the skills and tools needed to succeed

Experience developing and maintaining procedures for tracking, appealing, and resolving denials to improve reimbursement rates

The Denial Management Program Manager leads the UCDH's efforts to identify, analyze, and resolve claim denials, ensuring appropriate reimbursement and financial performance

In-depth understanding of the issues, processes, reporting instruments, metrics, dashboard design, and other tools and techniques involved with measuring and analyzing the revenue cycle

Ability to interpret a large volume of data and report it in a concise, meaningful manner

Excellent leadership and team management skills to provide guidance and oversight to denials analyst(s)

Knowledge of hospital billing and reimbursement procedures for Commercial/Managed Care and Government payers and the ability to recognize when policies are not being followed

Knowledge of professional billing and reimbursement procedures for Commercial/Managed Care and Government payers and the ability to recognize when policies are not being followed

Proficiency in Epic denial reporting and workflows

Detail-oriented and organized, with the ability to manage multiple priorities and effectively communicate findings

In-depth knowledge of the practices, procedures, and concepts of the healthcare revenue cycle and its component operations, including billing, collections, charge capture, contractual adjustments, third-party reimbursements, and cash management

Knowledge of healthcare compliance regulations and payer guidelines related to denials

Strong ability to advise management, serving as a technical expert, providing proposals for improvement and guidance on regulatory changes and industry trends and developments in revenue cycle management

Technical knowledge of all licensed health care service plans, including State and Federal plans, billing policies and procedures, and the ability to recognize when they are not being followed

In-depth knowledge of medical billing, coding (CPT, ICD-10, and HCPCS), and payer guidelines

Advanced organizational and project management skills and ability to lead a team, prioritize tasks, and see projects through from inception to completion on schedule

Ability to react with flexibility and patience and maintain efficiency and accuracy under sustained and immediate pressure created by a heavy workload, frequent interruptions, and multiple, sometimes competing, requests

Advanced communications skills can interpret and convey complex clinical finance information in a clear, concise manner

Ability to prepare compelling and informative reports and presentations to all levels of staff and management and with the ability to work effectively across departments

Advanced skills in report development and various software tools specific to healthcare revenue cycle management

Written skills to compose correspondence to parties outside the department and sufficiently communicate to other units within the department

Math skills to accurately add, subtract, multiply and divide

Develops and implements changes to systems, policies, and procedures to maintain currency in government regulations, reimbursement issues, and other matters having a potential financial impact

Demonstrates professionalism, tact, courtesy, and diplomacy in dealing with personnel at all levels outside the health system

Ability to review the work product of departmental employees and report findings

Ability to work accurately and quickly under pressure to meet deadlines set by the department, government programs, or private insurance carriers

Advanced interpersonal skills, with the ability to collaborate effectively on highly complex projects in a team environment with various business and clinical areas

Knowledge and skill in working with committees and user groups to facilitate group decision-making

Expert knowledge of and demonstrated skill with various spreadsheet and software applications including Microsoft excel and word, Clearinghouse, Contract Management, and Patient Accounting Systems

Ability to work cooperatively and constructively with employees and Administration

Ability to develop evaluation criteria for improving departmental activities/programs

Ability to develop reports or correspondence as required

Ability to use billing codes, including CPT, HCPCS, Revenue Codes & ICD-9/10

Reading skills to understand department policy and to read correspondence from within and outside the business office

Knowledge of significant healthcare trends and issues that affect physicians, hospitals, and academic health centers

Knowledge of Epic billing system, fundamental functions, database structure, and reporting capabilities

Typing skills sufficient to operate computer terminal, prepare correspondence for both within and outside the department

Strong analytical and problem-solving skills with the ability to interpret complex data and translate it into actionable insights

Demonstrated success leading cross-functional programs, initiatives, or operational improvement efforts

Effective communicator with strong facilitation and relationship-building capabilities

Experience planning, managing, and evaluating denials management functional areas daily

Identify opportunities to improve processes and act as a catalyst for realizing these improvements

Good analyzing skills in identifying root causes of denial trends and recommending strategies to minimize recurring issues

Preferred

Related degree preferred

Academic institution or large integrated health system is preferred

Experience working with interfaced/integrated multi-vendor applications preferred

Benefits

High quality and low-cost medical plans to choose from to fit your family's needs

UC pays for Dental and Vision insurance premiums for you and your family

Extensive leave benefits including Pregnancy and Parental Leave, Family & Medical Leave

Paid Holidays annually as stipulated in the UC Davis Health Policies or Collective Bargaining Agreement

Paid Time Off/Vacation/Sick Time as stipulated in the UC Davis Health Policies or Collective Bargaining Agreement

Continuing Education (CE) allowance and Education Reimbursement Program as stipulated in the UC Davis Health Policies or Collective Bargaining Agreement

Access to free professional development courses and learning opportunities for personal and professional growth

WorkLife and Wellness programs and resources

On-site Employee Assistance Program including access to free mental health services

Supplemental insurance offered including additional life, short/long term disability, pet insurance and legal coverage

Public Service Loan Forgiveness (PSFL) Qualified Employer & Student Loan Repayment Assistance Program for qualified roles

Retirement benefit options for eligible roles including Pension and other Retirement Saving Plans.