Denial Management Manager - Zanesville, United States - Genesis Healthcare System

Description

Position Details

:

Work Shift:

Day Shift (United States of America)

Scheduled Weekly Hours:

40

Department:

Denial Management

Overview of Position:

Manages the daily operations of the appeals management and pre-authorization process for Genesis. This position is responsible for the oversight, development and implementation of the strategies and tactical aspects associated with the above various areas of operations. This position works closely with all hospital departments and vendors to secure authorizations for services rendered and to decrease denials. This position must maintain an awareness of payer guidelines and updates, and proactive circulate changes to secure a standard authorization process. Develops strategies to optimize staff performance through process redesign, policy/procedure implementation, communications, and outcome feedback. Maintains Epic fields within the billing process to assure compliance to billing and regulatory requirements. Works with third party payors, oversees patient complaints, conducts employee training and performance evaluations. The manager is expected to motivate staff to achieve highest levels of customer satisfaction and to meet the organizational goals for revenue cycle performance. Focus on identifying best practice revenue cycle process improvement initiatives and outcomes with attention to quality, efficiency, and cost.

ESSENTIAL DUTIES
1. Responsible for the oversight, development, and implementation of strategy and tactical
2. aspects of prior authorization and appeals management processes.
3. Analyzes CMS memorandums and payor reimbursement methodologies (Commercial and Government). Performs research reviews of process changes associated with new regulations and implements a compliant process for the system.
4. Analyzes daily financial data to determine areas of leakage and partners with departments to optimize collections and improve the capture of authorization. Performs root cause analyses with denial trends to share with appropriate service line leaders.
5. Assures appeals are completed and filed timely and accurately, to maintain cash flow and optimize collections.
6. Monitors appeals and DRG audit process to maintain cash flow and optimize collections.
7. Collaborates and serves as a liaison to utilization management specialist to optimize collections and maintain an awareness of the challenges. In addition, supports their action plans and the interventions put in place by the utilization management specialist.
8. Develops strategies to optimize staff performance through process redesign, policy/procedure implementation, communications, and outcome feedback.
9. Has oversight of denial/appeal processes to ensure timely follow-up interventions are accurate, reflective of operations, and appropriate based on regulatory.
10. guidelines. Understands the financial impacts associated with these denials and works closely with utilization management specialist to implements strategies to prevent and minimize denials.
11. Liaison to all hospital departments as it relates to billing, coding, denials, and CMS coverage guidelines.
12. Demonstrates effective communication skills to collaborate with a variety of persons, including the patient, public, coworkers, guests, payers, outside agencies, and medical staff.
13. Provides outstanding customer service to internal and external customers.
14. Modifies department performance standards using benchmark data to provide the highest quality of service.
15. Demonstrates a willingness to accept new roles and responsibilities to support the achievement of organizational goals.
16. Effectively manages financial and material resources to control cost and adhere to department budget.
17. Seeks opportunities to acquire more skills and abilities in support of professional and personal goals.
18. Establishes and follows through with annual performance and development goals to help the department and organization reach their overall goals.

QUALIFICATIONS
1. Bachelor's degree preferred. In lieu of degree, 3-5 years of supervisory and field related experience is required, along with certification of achievement obtained within the first 18 months of employment.
2. Ability to motivate and organize people efficiently.
3. Excellent computer system knowledge and PC skills.
4. Ability to work under pressure and promote a positive working atmosphere.
5. Ability to lead and manage diverse staff in a learning environment with frequent changes in department priorities.
6. Ability to recognize necessary changes in priority of tasks and allocation of resources, and act upon them as required to meet workload balance.
7. Possess effective communication skills both verbally and written.
8. Excellent critical thinking, decision-making, problem solving, and analytical skills required.

PATIENT CENTERED CARE & BEHAVIORAL EXPECTATIONS
1. Living the Genesis Mission, Vision and Values

• Performs work in a manner that is quality focused.

• Treats patients, co-workers, visitors and volunteers with courtesy, compassion, empathy and respect.

• Results oriented and focused on achievement of objectives.

• Acknowledges and responds to the diversity of people and the situation.

• Encourages peers (others) to be owners of change.

• Always makes the effort to anticipate and exceed customer needs and expectations.

• Possesses the ability to engage others with patience and understanding.

• Acts in a manner that creates positive first and lasting impressions.

• Demonstrates the ability to own issues until they are resolved.
2. Patient Centered Care (patients/families, physicians, co-workers, all other internal/external customers)

• Introduces self and role...connects with everyone.

• Communicates effectively (i.e. advising others of actions, pertinent information, time durations, etc.) and asks for feedback.

• Asks for and anticipates needs and concerns of others.

• Maintains a positive work environment for staff and a healing environment for patients (i.e. safe, clean, quiet, etc.)

• Maintains the dignity and privacy of each person; manages confidential/sensitive information appropriately.

• Responds to requests in an appropriate and timely manner.

• Exits patient/customer encounters courteously, asking if there are additional needs that can be addressed.
3. Promotes Patient and Employee Safety

• Demonstrates safe Patient Handling (i.e. transfers, transport, care administration, nutrition, medication, etc.)

• Demonstrates safe Materials Handling (i.e. appropriate use and disposal of chemicals, infectious wastes, etc.)

• Demonstrates appropriate knowledge of Infectious Disease precautions and use of proper protective equipment

• Demonstrates Slips/Trips and Falls Awareness.

• Actively contributes to maintaining a safe, clean and quiet environment.

WORKING CONDITIONS/PHYSICAL REQUIREMENTS
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Works in an office environment.
2. Travels to other floors and to centralized files. May be required to drive to other locations. Answers telephone calls, uses personal computer and other business machines extensively. Bends, reaches, pushes and pulls file drawers to file records and reports.
3. Regularly lift or move up to 10 pounds, frequently lift or move up to 25 pounds and occasionally lift or move up to 50 pounds.
4. Vision abilities required include up close vision, peripheral vision, depth perception and the ability to adjust focus.
5. May be required to periodically rotate shifts and regular days off. All system employees must be willing to work all shifts, extra hours, holidays and emergency shifts as required.

Benefits include:

Medical and dental insurance

Vision insurance

Healthcare spending account

Dependent care spending account

Basic life insurance

Disability insurance

Tuition reimbursement

Employee Assistance Program

Paid time off

Retirement plan with employer match

Opportunities for professional development

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