CLINICAL DENIALS MANAGER

Riverside Healthcare•Kankakee, IL

1d•Onsite

About The Position

The Clinical Denials Manager at Riverside Healthcare is responsible for overseeing and managing the staff assigned to follow-up and collection of accounts, ensuring efficient resolution of claims and denials. This role includes developing and implementing information applications related to managed care contracts, providing end-user support, and maintaining the policy and procedure database for the department. The Clinical Denials Manager works closely with patients, customers, third-party payers, attorneys, and collection agencies to resolve billing and collection questions. The role also involves identifying trends in denials, implementing solutions, and improving all system functions related to denials.

Requirements

Three years of hospital revenue cycle experience within the last five years is preferred.
Collection experience or insurance background is beneficial.
Ability to work independently with minimal supervision.
Excellent guest relations skills, including strong verbal and written communication abilities.
Extensive knowledge of billing requirements across various payor types, including Medicare, Medicaid, DASA, HMO, PPO, and others.
High school graduate or equivalent

Nice To Haves

ICD9/CPT/Medical terminology preferred

Responsibilities

Oversee and manage the staff responsible for the follow-up and resolution of claims and denials.
Perform timekeeping duties for the department, ensuring accurate tracking of hours worked.
Assist staff with high-level appeal documentation and provide guidance on complex denial cases.
Develop, implement, and maintain the policy and procedure database for the department, ensuring up-to-date and effective guidelines for staff to follow.
Work with patients, customers, and third-party payers to resolve billing and denial questions.
Attend payer calls monthly, escalating issues related to denials as necessary.
Identify trends in denials, evaluate potential resolutions, and implement corrective actions to minimize future denials.
Send monthly audit information related to commercial and advantage audits as well as RAC (Recovery Audit Contractor) to the Director of Revenue Integrity.
Maintain extensive knowledge of Medicare/Medicaid/DASA/HMO/PPO and miscellaneous billing requirements as defined by contract, state, or federal law.
Prepare documents required by payers, internal and external auditors, ensuring compliance with regulatory standards.
Work with outside attorneys and collections agencies to manage and resolve outstanding accounts.
Implement solutions to improve the efficiency and effectiveness of the denials management process.
Perform other patient accounts functions as needed to support the overall financial operations of the organization.
Participate in special projects and initiatives as assigned by senior management.