Manager of PARR Services - Lake Success, United States - Health/ROI

Description

Job Description

Job Description

Employment Type: Full Time, 40 hours/week. In-Office – THIS IS NOT A REMOTE POSITION

Responsibilities

• Responsible for managing Health/ROI's clinical denial practice including directly hiring. training and managing the Practice's clinical staff. With support from Health/ROI's President and Vice President develop and implement a strategic plan for the practice and mechanisms to measure staff's productivity and quality performance. Responsibilities will include working with the PARR Operations Manager and the Director of IT to assure that staffing is adequate, properly trained and areas to improve productivity are identified and implemented. Lastly, work with Health/ROI's President and Vice President to develop an ongoing marketing and communications program with existing clients and potential clients.
• Ensure that appeals are categorized and processed within appropriate payer, state and federal timeframes.
• Develop and/or improve tools to identify denial trends and patterns so they can be efficiently shared with existing and potential clients
• Work to review, evaluate and improve the enterprise clinical denial and appeal process.
• Supports the development of policies, procedures and training material necessary to drive process improvement and staff performance within the organization
• Identifies process gaps and trends to support client facility quality improvement
• Participates as a Hospital advocate for telephone Medicare (ALJ) hearings to facilitate denial resolution
• Provides clinical review support to Arbitration/Litigation actions as required
• Performs other duties as assigned

Requirements

• Attention to detail, strong organizational skills and self-motivated.
• Ability to independently & accurately make decisions and assimilate multiple data sources or issues related to problem solving.
• Ability to work under a timeline/deadline, prioritize work and maintain accurate records of completed work
• Strong Computer skills and Data Literacy
• Competent in Microsoft office including Excel
• Excellent English Language Communication skills – both written and verbal
• Knowledge of Medicare or Medicaid regulations
• Knowledge of CPT/HCPCS and ICD codes preferred
• Effective time management skills, and be results driven
• Must have the ability to multitask with strong organizational skills
• Ability to work in a fast-paced environment with deadlines
• Perform other duties as may be assigned by management.

Qualifications (not sure what to write)

• A minimum of 3-5 years of experience applying both clinical and coding knowledge in writing clinical appeals
• Must hold either CCS, CIC or CDIP certification or evidence the ability to obtain certification within 6 months of hire.
• Minimum 3 years clinical experience in an acute care setting
• Current RN license or other professional license
• Foreign Medical Graduates, Certified Coders also eligible

Company DescriptionHealth/ROI supports hospital revenue cycle efforts by performing advanced level work related to Clinical Denials Management. Join our team of professionals who have been providing revenue cycle services to the health care marketplace for over 35 years. This position offers growth for the right person – and the chance for you to make your mark in a growing company. We are looking for a sharp, savvy clinical professional with experience in writing clinical appeals for DRG validation and medical necessity. The person that we are looking for will have strong clinical skills and experience, will have managerial experience, leadership skills and communication skills. They will be responsible for directing this practice area which includes 25 full and part time clinical staff (RN's and FMGs) and 15 operations staff. This is an office-based position located in Nassau County, NY. We offer competitive salary and comprehensive benefits including an employer sponsored pension plan.

Company Description

Health/ROI supports hospital revenue cycle efforts by performing advanced level work related to Clinical Denials Management. Join our team of professionals who have been providing revenue cycle services to the health care marketplace for over 35 years. This position offers growth for the right person – and the chance for you to make your mark in a growing company. We are looking for a sharp, savvy clinical professional with experience in writing clinical appeals for DRG validation and medical necessity. The person that we are looking for will have strong clinical skills and experience, will have managerial experience, leadership skills and communication skills. They will be responsible for directing this practice area which includes 25 full and part time clinical staff (RN's and FMGs) and 15 operations staff. This is an office-based position located in Nassau County, NY. We offer competitive salary and comprehensive benefits including an employer sponsored pension plan.