Supervisor Clinical Denials - RN
Supervisor Clinical Denials - RN
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Not Disclosed
Salary Not Disclosed
1 Vacancy
Job Description
This supervisor will oversee team members in all duties related to Denial Management and Revenue Recovery functions by providing guidance and quality audits related to admission reviews concurrent reviews retrospective chart reviews and clinical systems reviews to measure clinical performance. The supervisor will assist in the development oversight and refinement of the clinical and administrative skills and/or knowledge to maximize revenue recovery on hospital-based claims. They will also work claims and provide SME support.
Responsibilities
- Supervise the Denials & Revenue Recovery RN team
- Oversees day to day operations of the Denial Analysts and the Managed Care Contract Auditors.
- Promotes the quality and efficiency of the departments performance and through participation in staff educational programs approved continuing education courses and specialized skill training programs
- Utilizes all equipment supplies facilities and resources in a prudent and efficient manner to ensure efficient departmental operations and the provision of high-quality health care services.
- Seeks opportunities for process improvements based on collaboration and communication with team members and stakeholders
- Process clinical denials and appeals and Support team as SME
- Utilizes analytical ability required to gather data. Uses clinical judgment to apply predetermined criteria or uses independent clinical judgment when no predetermined criteria exist to identify problems facilitate resolution recommend corrective action and report results effectively.
- Proactively researches and understands payer issues. Troubleshoots and resolves issues that impact revenue recovery.
- Collaborates with payors revenue cycle leaders and other stakeholders to continually improve internal and external processes related to denials management and government audit activity.
- Other duties as assigned
Qualifications
- 5 years as a Registered Nurse in a clinical setting
- 2 years experience in supervisory capacity at hospital clinic or revenue cycle supervisor
- Graduate of an accredited school of nursing
- Bachelor of Science in Nursing (BSN) Bachelor of Business Administration (BBA) or Bachelor of Science in Business Administration (BSBA)
- Knowledge of medical terminology anatomy and physiology diagnosis surgical procedures and basic disease processes.
- Analytical ability required to gather data decide on conformity based on predetermined criteria identify problems and refer for resolution.
- Basic knowledge of medical records coding standards.
- Awareness of licensing and accreditation standards.
- Proficient with Microsoft Office.
- Knowledge of billing practices identification of billing problems adequacy of documentation and ability to conduct research of issue at hand as well as formulate recommendations based on findings.
- Registered Nurse (Louisiana Mississippi or multistate); BLS Certification
Required Experience:
Manager
Employment Type
Full Time
