- Experience in managing a large volume of accounts while maintaining a high accuracy and positive outcomes.
- Strong knowledge of various types of payer denials, appeals, and underpayment management to ensure denials are appealed and resolved timely.
- Advanced knowledge of CPT, ICD-10 coding and billing, UB and 1500 billing.
- Advanced knowledge of Medicare, Medicaid and third party payment methodologies.
- Advanced knowledge of CMS Medicare regulations.
- Advanced knowledge of reading and understanding managed care contracts and federal and state regulations.
- Maintain professionalism working and collaborating with internal and external partners to promote positive outcomes.
- Intermediate PC experience required with knowledge of Excel and Word applications.
- Excellent verbal and written communication skills.
- Strong critical thinking and analytical skills.
- Self-motivated.
- Demonstrated ability to drive positive results and change management
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Management and Prevention- AL - Montgomery, United States - American Consultants
Description
Job Description
Job DescriptionDirector of Denials Management and Prevention- AL
American Consultants is looking for a permanent Director of Denials Management and Prevention for a facility in Alabama.
Summary:
The Director, Denials Management & Prevention shall oversee the centralized operations of denial review appeal, recovery and management of payer contracts. The Director will collaborate with leadership on the planning and strategic initiatives around technical and clinical denials, payer relations, and hospital collaboration while ensuring regulatorycompliance. This individual shall develop and maintain an organized and structured process for facilitating appeals and recoveries to ensure denials and underpayments are appealed in a timely manner in accordance with payer and regulatory requirements. The Director will audit, monitor, and trend denials and recoveries, identify performance and areas of opportunities including system, chargemaster, coding, and manual input. This individual will collaborate with key stakeholders identifying, developing, and implementing process improvement opportunities. The Director will partner with leadership to review existing payer contracts, identify potential pitfalls, and contract language barriers based on the review and analysis of current denial trends and underpayments. This individual will collaborate and assist in contract review and negotiations to ensure contract language will promote and enforce positive outcomes and resolution of claims.
Qualifications
Education / Experience: Bachelor's degree in a business or healthcare related field or equivalent education and experience. Minimum of at least 7 years' experience in revenue cycle in a healthcare system. Minimum of 3 years management experience required. Must have managed care experience. Director level experience at a sizeable hospital.
Knowledge, Skills, and Abilities:
