Director of Denials
PAS - Dallas - Irving, TX
Full-time, Contract

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The Denials Director will be responsible for daily operations of all functions and oversight of prebill denial team members and serve as the Service Center liaisons for denial projects, questions and meetings with, Division
Denials Director, Facility Leadership and other team members within the organization. This position will organize the structure of the program and hire all necessary staff to complete the program’
s objectives as well as monitor and track status of all departmental responsibilities. Establishing and maintaining relationships with all customers, including: SSC executive staff, prebill denial unit staff, PARS unit staff, hospital executive management team members, hospital and SSC department directors, payers, and others is a key responsibility. Additional
responsibilities may include conducting onsite visits to facilities and payers, assessing workflows and operations.

The prebill denials director responsibilities include mandatory root cause analysis of prebill denials and work collaboratively with PARS director to understand root cause and trends to decrease new denials and final write off denials by identifing operational opportunities that will decrease denials overall, such as contract language, patient access process changes, case management collaboration, appeal opportunities, etc. In addition, the director will be responsible for monitoring, trending and communicating with SSC Leadership, Division Denials Director and Facility Leadership regarding denial trends identified via the Meditech Insurance Exception Reports, New Denials and Final
Write Off Denials.

Must demonstrate strong commitment to stakeholder relationships by taking ownership of issues and facilitating effective outcomes in a timely manner.

Qualifications
Analyze insurance denial trends identified using the Meditech Exception Reports, New Denials and Final Write Off denials and work with SSC Departments, Division and Facility Leadership to implement process improvements to resolve and reduce denials
 Daily oversight of daily Meditech reports, analysis and resolution of denials prebill
 Understand and communicate contract specific issues related to denials for all payors, except Medicare to Strategic Pricing Analytics
 Monitor, trend and communicate significant shifts in market or operating conditions to SSC Leadership, Division
and Facility Leadership
 Manage daily activities related to Prebill denials unit, ensuring processes are performed efficiently and effectively
 Establish and maintain relationships with all customers, including: SSC executive management team, hospital executive management, SSC and hospital department directors, UR staff, payers and others as needed or required
 Review each staff member’s productivity and QA on a monthly basis and perform annual evaluations
 Hire all necessary staff to perform departmental operations
 Establish productivity and QA standards including controls and review mechanisms for SSC policies and procedures
 Monitor and track status of department responsibilities
 Counsel staff with QA and productivity issues
 Adhere to all current Compliance requirements
 Maintain strictest confidentiality to ensure that privileged and/or proprietary information is adequately safeguarded against disclosure
 Practice and adhere to the “Code of Conduct” philosophy and “Mission and Value Statement”
 Other duties as assigned
Knowledge, Skills & Abilities
Understands basic payer rules which affect reimbursement and/or compliance requirements
 Understands case management operations and workflow as it relates to the communication and authorization process with all Payors (except Medicare).
 Familiarity with major components of Revenue Cycle; including patient registration, coding, charging, managed care, utilization review, etc.
 Policies & Procedures - articulates knowledge and understanding of organizational policies, procedures and systems
 Detail oriented and able to work with minimal supervision
 Able to supervise staff and organize the structure of the program
 Leadership – guides individuals and groups toward desired outcomes, setting high performance standards and
delivering leading quality services
 Customer Orientation – establishes and maintains long term customer relationships, building trust and respect by
consistently meeting and exceeding expectations
 Communication - communicates professionally, clearly and concisely
 Tactical Execution – oversees the development, deployment and direction of complex processes
 PC Skills – demonstrates proficiency in Microsoft Office applications and others as required
 Organization - proactively prioritizes needs and effectively manages resources
 Project management – ability to identify and communicate project goals, schedules, responsibilities, progress and
performance
 Teambuilding - demonstrates ability to foster and perform in a team-building environment
 Financial management - applies tools and processes to successfully manage to budget
EDUCATION
 Bachelor’s Degree in Business or related field
 Equivalent work experience may substitute degree requirement