Director of Denials
Shared Services - Houston - Houston, TX

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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.

Oversight areas:
Meditech Exception Reports for all payors, except Medicare – Post discharge, prebill

Prebill denials, new denials and Final write off denials root cause and trending

Drive the enterprise wide Denials Action Team Project

Monitors and reports on execution of Denial Action Teams action plans

Monitor, trend and communicate denial reduction opportunities identified through root cause analysis to SSC Leadership, Division Leadership and Facility Leadership

Implement action plans to reduce denials

Verification of authorization of services after discharge but prior to final bill

Validation of authorization in payor system prior to claim submission as needed

Re-certification for additional days after discharge but prior to final bill

eRequest queues as determined during program implementation

OPERATIONAL DUTIES INCLUDE BUT ARE NOT LIMITED TO:
Analyze insurance denial trend

s

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

Qualifications

EDUCATION

  • Bachelor’s Degree in Business or related field
  • Equivalent work experience may substitute degree requirement
EXPERIENCE

  • Appeals, denials, managed care contracting, experienced preferred
  • Previous management experience required
  • Some travel may be required

HCA Inc - 13 months ago - save job - block
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