Manager, Denials and Appeals

JOB SUMMARY: 

Effectively leads denials management team within billing, collections or accounts receivable management, maintaining a full understanding of the billing information system. Manages the activities of staff through daily supervision while overseeing the denials management functional area across revenue cycle including but not limited to billing and eligibility functions. Assists with implementing strategic goals by deploying internal and external staff.

PRIMARY RESPONSIBILITIES: 

• Manage the production and oversight of a large remote team within the denials management department.
• Provide direction to self and others in areas of responsibility such as research, appeals and payment posting.
• Assists with feedback for hiring, discipline and performance evaluations.
• Provides department orientation and ongoing training for all in/direct reports.
• Liaison with internal departments to promote ongoing communication, and collaboration on cross functional projects related to denials management.
• Analyzes reimbursement from all sources, including carrier reimbursement exception reporting and follow up pending claims analysis and denials management.
• Represent organizational projects and assist management with follow-through and implementation of initiatives.
• Manage all aspects of the denials management department including the timely, accurate submission and collection of all patient and customer accounts.
• Works with across departments to manage the entire process from insurance verification to final collection.
• Responsible for the timely accurate submission of all claims for service to the responsible payer.
• Ensure that all payers are set up correctly within the software system.
• Monitors and validates adherence to Policies and Procedures, auditing as necessary. Monitors and evaluates employee productivity and performance to goal.
• Builds employee morale, motivation and loyalty by fostering positive working relationships.
• This role works with PHI on a regular basis both in paper and electronic form and has access to various technologies to access PHI (paper and electronic) in order to perform the job

QUALIFICATIONS:

• Bachelor’s Degree in related field, or equivalent years of work experience required
• Minimum of 5 years of experience in managing a high-volume, fast-growing billing office, within the laboratory setting is preferred.
• Extensive knowledge of reimbursement, billing, coding and compliance regulations is required.

SKILLS, KNOWLEDGE AND ABILITIES:

•  A minimum of two (2) years of directly related and progressively responsible experience.
• Ability to perform complex analysis and discuss with upper management.
• Skilled in Microsoft Office (Word and Excel) as well as G Suite 
• Ability to communicate effectively both orally and in writing.
• Strong interpersonal skills.
• Strong organizational skills, including attention to detail.
• Knowledge of payer eligibility and benefits.
• Healthcare research and analysis skills sufficient to support payer research within the healthcare policy library and state management system

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