Denials Management Supervisor (FT Salaried)
Blanchard Valley Regional Health Center

Job Info

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PURPOSE OF THIS POSITION

The primary purpose of the Denials Management Supervisor is to oversee the denials management specialists who work to resolve denials for third-party payers, as well as vendor denials management relations. This includes supervising the denials process used by both the internal associates and denial management vendors. The supervisor will collaborate to set department goals, measure process effectiveness, and identify the need for updated policies and procedures. The supervisor will act as a liaison on behalf of the denials management specialists to both internal and external departments. The supervisor provides education and training to the denials management team and coordinates same with denial management vendors to ensure consistent and standardized processes.

JOB DUTIES/RESPONSIBILITIES

• Duty1: Maintains supervision of the in-house denials management specialist team. Oversees and monitors workflows, work queues, Quadax, staffing levels, and participates in the hiring and training of new associates. Performs formal performance evaluations and works with department leadership to counsel employees on performance and/or work behaviors that do not align with the organization. Maintains payroll, time off requests, and monitors attendance to ensure proper coverage.
• Duty 2: Oversees vendor denial management relationship, including staffing needs, access, and communication to ensure internal process is being followed.
• Duty 3: Interacts directly with the denials management specialist team, including denial management vendors, to engage in problem-solving. Identifies and participates in continuous quality improvement initiatives across the denials management team and other functional areas to streamline processes. Serves as a resource to resolve questions and/or concerns of the team.
• Duty 4: Provides direction and support to the denials management team by adhering to an established education plan to ensure quality and productivity standards are met. Assists in the development and needed revisions to maintain current materials and plan. Actively participates in continuing education opportunities to remain current and promote best practices. Leads denial management huddles.
• Duty 5: Oversees the appeals process, which includes assessing and guiding the resolution of denials received, identified by a denials management tool and/or a denials vendor. Work in collaboration with the denials management specialists to ensure accurate methods of submitting appeals. Monitors and ensures that denials are addressed in a timely manner to the responsible payer.
• Duty 6: Meets with various revenue-generating departments, in collaboration with other internal and external teams, when appropriate, to communicate identified root causes of denials and participates in collaboration on how to mitigate denials in the future. Contributes to the steady reduction of preventable denials.
• Duty 7: Develops standard work to ensure continuity, accuracy, and efficiency in the processes of the denials management team. Holds associates accountable to follow the established processes and expectations. Assists in developing revenue integrity-related departmental, division and/or organizational policies and procedures for recommendation and approval, as necessary.
• Duty 8: Reviews, approves, and posts adjustments based upon the Denial Write-Off Approval Levels. Uses the adjustment tracker to identify any opportunities in trends and provide feedback and education to adjustment tracker users and opportunities education.
• Duty 9: Maintains a proficiency in the systems used to support the functions of Revenue Integrity processes such as Oracle, Quadax, Experian, Forvis, Axiom, MyCGS, payor portals, etc.
• Duty 10: Establishes and monitors key performance indicators. Develops standardized reporting. Creates and presents denial reports/summaries and dashboards to provide denial related activity to leadership, stakeholders, and clinical departments that is meaningful to the end user.
• Duty 11: Reviews denial appeal practices to evaluate for opportunities and educate to the best practice for responding to denials, focusing on ensuring the inclusion of all necessary documentation, meeting NCD, LCD, and payer policy guidelines for coverage. Provide feedback on ensuing a complete initial appeal to reduce the likelihood of a subsequent denial. Utilize quality audits to identify trends for education and training.
• Duty 12: Works with the Denials Prevention Analysts on preventive denials and avoidable write-offs to identify any spikes or positive impacts of new process implementation. Monitors key performance indicators to track performance improvement activities and recognize important trends. Reports findings to the Revenue Integrity Compliance Committee.
• Duty 13: Knowledgeable in professional and hospital billing processes, including but not limited Medicare Code 44, Overlapping Services, Part B inpatient services, the CMS-1500 and CMS-1450 claim forms.
• Duty 14: Demonstrates superior understanding of federal, state and third-party charging guidelines. Analyzes revisions to coding and billing regulations, including OPPS and IPPS as appropriate revisions, by resourcing credible references (i.e. CMS website, Craneware, publications, professional contacts, reliable internet sources, seminars, etc.).
• Duty15: Regularly attends and actively participates in in-services, organizational meeting. Utilize lean management tools (e.g. huddles, idea boards, A-3 process, mapping, etc.) and continuing education programs as offered in order to remain current with organizational and industry changes and best practice. Communicate and disseminate information to other departments as applicable.

REQUIRED QUALIFICATIONS

• An associate degree in a related field including, but not limited to, health information, business, healthcare finance or related clinical profession required or 3+ years' experience from which comparable knowledge and abilities have been acquired.
• Three (3)+ years denial and/or billing experience working with commercial and government payer types for professional and/or facility claims.
• CCS, CCS-P, CPC, or AAPC specialty certification required within 6 months of hire.
• CPFSS certification within 12 months of hire.
• Regulatory, compliance, and reimbursement methodologies knowledge required. Ability to research, review, analyze, and interpret Federal, State and Local billing and coding regulations.
• Demonstrated ability to navigate through commercial and government agency payer websites, to research and understand billing requirements, instruction, and payer guidelines.
• Ability to effectively present data and complex information in an informative and meaningful way to a variety of audiences, including leadership.
• Ability to effectively educate all levels of the organization with small and large audiences (e.g. coders, clinical departments, medical staff, executive staff, etc.)
• Ability to manage complex issues and manage multiple tasks/projects. Excellent organizational and time management skills; detail oriented and follow through. Self-directed.
• Excellent computer skills and the ability to create reports, dashboards, and presentations using Word, PowerPoint, moderate skills in Excel required, and other office products.
• Strong interpersonal skills, critical thinking skills, and communication skills. Strong problem-solving, research and analytical skills required.
• Ability to maintain a positive attitude and outlook, has passion for the mission, visions, and values of the organization, promoter of teamwork, ability to resolve conflict, and a believer in staff development.
• A valid driver's license is required (if you do not have a valid Ohio driver's license you must obtain one within 30 days of your residency in the state). You must also meet BVHS's company fleet policy and insurance company requirements, and any other requirements that may be required to operate a vehicle.
  

PREFERRED QUALIFICATIONS

• Bachelor's degree in a healthcare related field.
• Certified Professional Biller (CPB) certification

PHYSICAL DEMANDS

This position requires a full range of body motion with intermittent activities in walking, lifting, bending, squatting, climbing, kneeling, and twisting. The associate will be required to sit for five hours a day. The individual must be able to lift ten to twenty pounds and reach work above the shoulders. This position requires corrected vision and hearing in the normal range. The individual must have excellent eye-hand coordination and verbal communication skills to perform daily tasks.

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