Denials Project Manager
Denials Project Manager
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$ 58000 - 85000
1 Vacancy
Job Description
Job Summary
Supports and is responsible for incorporating into job performance the Frederick Health (FH) mission vision core values and customer service philosophy and adheres to the FH Compliance Program including following all regulatory requirements and the FH Standards of Behavior.
Under indirect supervision leads denial reduction and prevention efforts within individual hospitals and as appropriate across hospitals. Responsible for analyzing denial trends prioritizing denial reduction efforts determining root causes for denials and developing denial prevention solutions. Works closely with Patient Access Clinical Leaders Health Information Management Patient Financial Services and other departments in denial reduction efforts. Facilitates the development and implementation of policies procedures performance tracking goal setting and accountability. Develops executive level presentations that explain plans findings solutions and performance.
Example of Essential Functions:
- Responsible for the leadership and follow up of monthly Denials Team Meetings. Appeals denials as needed.
- Tracks volumes revenue and denials in Infusion and Radiation Medicine departments. Presents leadership with data solutions and progress towards goals.
- Works collaboratively with Patient Accounts team to identify denial trends across the Oncology Service Line investigate root cause implement solutions and track effectiveness of those solutions.
- Fosters working relationships with the Infusion Center Pharmacy Lab and Radiation Medicine leadership so workflows can be established that mitigate denials. Establishes policies and procedures for same.
- Actively engages with Compliance to ensure billing coding and documentation practices are meeting standards.
- Responsible for Charge Master updates modifications and staff education around same.
- Stays current on CMS and insurance coverage criteria for services and drugs provided in Infusion and Radiation Medicine.
- Maintains LEAN approach to workflows.
Required Knowledge Skills and Abilities:
- Proficiency and accuracy in the use of software programs such as MS Word Excel PowerPoint Access and Outlook.
- Proficiency in extracting data from multiple software systems such as HIS systems Data Repositories and Electronic Billing Systems
- Proficiency with creating sophisticated databases and Excel pivot tables
- Ability to create professional executive reports
- Ability to analyze data to validate report outcomes and results
- Attention to detail to assure accuracy of reports and data is required.
- Possess problem solving skills to solve data integrity issues.
- Able to create compose and edit written materials.
- Proficiency in denial concepts
- Ability to learn hospital information systems and departmental software programs.
- Ability to work independently prioritize projects and meet deadlines.
- Ability to work with other departments and vendors independently
- Excellent communication skills both verbal and written.
- Strong organizational skills and ability to prioritize and manage multiple tasks.
- Ability to work in a dynamic work environment
- Ability to work professionally with a diverse population base.
- Able to maintain a high level of confidentiality.
Minimum Education Training and Experience Required:
- Minimum seven years prior experience in a health care revenue cycle and two years of experience managing projects required. Demonstrated proficiency in denials and presentation skills required.
Caring for you as you care for the CommUNITY
Frederick Health offers a comprehensive and affordable benefits package. Health Dental and Vision insurance are offered the 1st of the month after 30 days of employment to all employees hired to work at least 20 hours per week and offer multiple plans to best meet you and your family needs. Life insurance Short-Term Income Replacement and Long-Term Disability are employer paid for eligible employees. Frederick Health offers a robust Paid Time Off program for eligible employees. Our 403B retirement plan helps you save for your retirement and includes an employer match to eligible employees. All employees have access to free financial planning sessions. We also offer an educational assistance program to support your education goals as well as an employer paid Employee Assistance Program.
Pay is based on experience skills and education. Exempt positions under the Fair Labor Standard Act (FLSA) will be paid within the base salary equivalent of the stated hourly rates. The pay range may also vary within the stated range based on specialty if applicable. Non-Exempt positions may have shift differential and/or Overtime paid if applicable.
Pay range: $58000 - $85000
Required Experience:
IC
Employment Type
Full-Time
