Director Denial Management and Prevention (RN)

About this Job: General Summary of Position

The Director Denial Management & Prevention is responsible for directing and administering the programs and activities of a denial prevention and recovery operations. In partnership with the VP Clinical Resource Management the Director will lead planning and execution of strategic initiatives around technical and clinical/medical necessity denials and appeals across system hospitals.Primary Duties and Responsibilities

• Collaborates with VP Clinical Resource Management and other leaders to identify denial mitigation opportunities andreimbursement improvement processes.
• Oversees and directs appeals for the system to include oversight of any appeal vendors.
• Partners with system leaders to create implement and sustain improvements that contribute to the organization's goals.
• Provides strategic direction and clinical oversight for hospital denials and appeal operations and outcomes.
• Works with organization leaders to develop performance goals and objectives based on industry best practices andsystem benchmarks.
• Develops and maintains analytics and dashboards to standardize entity denial summaries.
• Supports system denial mitigation projects and serves as a consultant for individual entities regarding denial trends andinterventions.
• Works with Acute Case Management teams focusing on operational improvements and team education to support denialreduction.
• Collaborates with the Managed Care team to summarize and address payer opportunities.
• Works with Corporate Compliance and Rates and Reimbursement team to ensure operations and policies conform tocurrent governmental and state regulations.
• Manages business partner/vendor contracts holding them accountable to contractual obligations and both industry andorganizational benchmarks.
• Supports the optimization of technology to enhance operational efficiency and improve reimbursement.

Minimal Qualifications

Education

* Bachelor's degree in Nursing required

Experience

* 5-7 years 5-7 years of Revenue Cycle experience including appeals and financial clearance required and * Leadership experience in the healthcare industry with emphasis on revenue cycle preferred

Licenses and Certifications

* RN - Registered Nurse - State Licensure and/or Compact State Licensure required

Knowledge Skills and Abilities

* Team builder with excellent interpersonal skills * Strong analytical and problem-solving skills with high level of accuracy and attention to detail. * Strong verbal and written communication skills including presentation skills with ability to effectively interact with all levels of management internal departments and external agencies. * Computer skills are required to be efficient in managing data (Word PowerPoint Excel and email programs). Advance Microsoft Excel skills.

This position has a hiring range of : USD $114,004.00 - USD $219,960.00 /Yr.