Denials Prevention Director

Conifer Health Solutions • Frisco, TX

11d • $81,952 - $122,907 • Onsite

About The Position

This is a client facing process improvement position. Liaison between facility and Conifer operations for multiple facilities. Executive resource for Conifer for client local leadership. Focused on growing on-site relationships via client revenue, reputation and image by service, and performance for the client. Critical responsibilities include: (a) engaging key client executive management to understand needs (b) working with Conifer internal business colleagues to assess, develop, and recommend denial service solutions; (c) educating the client, monitor denial performance objectives, prepare for and conduct monthly denial meetings, (d) report with peer-level operations personnel underlying metrics, and improvement opportunities to ensure it meets/exceeds the expected levels of performance, (e) ensuring the contractual expectations are met and exceeded, (f) setting strategy that continues to long-term strategy of overall client account. ESSENTIAL DUTIES AND RESPONSIBILITIES Include the following. Others may be assigned. Oversight Management – be conversant in the underlying denial operations and client environmental and placement metrics that drive the ebbs and flows in revenue and affect positive movement in each on a peer-level dotted line relationship with strategy and operations. Client Management -- Serve as primary on site contact for Denials Management and other key sponsors, present a knowledgeable, efficient, and professional image by handling business in a respectful and professional demeanor, and excel in the following activities: Client Advisor – Rise to the level of trusted advisor to Clients, with respect to Client’s own performance. Reporting and Analytics– Prepare and present to client performance reporting, as contracted and appropriate Relationship Management -- Facilitate and maintain relationships through regular, pro-active communication, timely follow-through on requests and coordination of resources to meet client needs Market based collaboration or prevention of denial contribution within accounts receivables. Function as leader of denial subcommittees to reduce failure rates from physician orders, financial clearance, admissions, clinical care management, documentation, discharge planning and appropriate revenue recognition. Company Policy. Adheres to all company policies and procedures including, but not limited to those identified within the Standards of Business Conduct and the Employee Handbook, as may be amended from time to time. Adheres to all applicable laws and regulations and the company's governance/compliance program. Responsible for reporting violations of the company's policies and procedures, Standards of Business Conduct, Compliance, governance program, laws and regulations through the company's Help Line or other mechanism that may be available at the time of the violation. Assists with internal control failure remediation efforts. Internal Controls and Training. Becomes knowledgeable of internal control responsibilities through training and instruction. Responsible and accountable for internal control performance within their area of responsibility. Participates in the internal controls self-assessment process. Ensures concerns with internal control design or performance and process changes that impact internal control execution are communicated to management.

Requirements

• Requires an understanding of systems and processes that impact revenue cycle performance and capabilities.
• Possesses the ability to build trusting relationships with Client Executives at all levels.
• Possesses analytical ability sufficient to work in a data-heavy environment and to identify trends in the data.
• Possess business acumen with an emphasis on: effective communication (i.e., listening, written and verbal), negotiation, influencing decision makers, business planning, strategy, problem solving, decision making and time management skills.
• Intermediate MS Office required (Outlook, Excel, Word, and PowerPoint).
• Demonstrated experience of the entire acute care hospital revenue cycle processes is required
• Successful experience leading in matrixed environment.
• Understanding of the market, trends, competition, and key pain points for hospital executives.
• Proven success in project management roles to include developing and implementing business initiatives, change management, and bringing together disparate team members to successfully deliver client solutions
• Three to Five years Supervisory in a Revenue Cycle or Acute Health Care.
• Must be able to work in sitting position, use computer and answer telephone
• Ability to travel (most driving within Division) 50% Travel Includes ability to walk through hospital-based departments across broad campus settings, including Emergency Department environments

Nice To Haves

• Bachelor’s Degree preferred.

Responsibilities

• Oversight Management – be conversant in the underlying denial operations and client environmental and placement metrics that drive the ebbs and flows in revenue and affect positive movement in each on a peer-level dotted line relationship with strategy and operations.
• Client Management -- Serve as primary on site contact for Denials Management and other key sponsors, present a knowledgeable, efficient, and professional image by handling business in a respectful and professional demeanor, and excel in the following activities: Client Advisor – Rise to the level of trusted advisor to Clients, with respect to Client’s own performance.
• Reporting and Analytics– Prepare and present to client performance reporting, as contracted and appropriate
• Relationship Management -- Facilitate and maintain relationships through regular, pro-active communication, timely follow-through on requests and coordination of resources to meet client needs
• Market based collaboration or prevention of denial contribution within accounts receivables.
• Function as leader of denial subcommittees to reduce failure rates from physician orders, financial clearance, admissions, clinical care management, documentation, discharge planning and appropriate revenue recognition.
• Adheres to all company policies and procedures including, but not limited to those identified within the Standards of Business Conduct and the Employee Handbook, as may be amended from time to time.
• Adheres to all applicable laws and regulations and the company's governance/compliance program.
• Responsible for reporting violations of the company's policies and procedures, Standards of Business Conduct, Compliance, governance program, laws and regulations through the company's Help Line or other mechanism that may be available at the time of the violation.
• Assists with internal control failure remediation efforts.
• Becomes knowledgeable of internal control responsibilities through training and instruction.
• Responsible and accountable for internal control performance within their area of responsibility.
• Participates in the internal controls self-assessment process.
• Ensures concerns with internal control design or performance and process changes that impact internal control execution are communicated to management.

Benefits

• Medical, dental, vision, disability, life, and business travel insurance
• Management time off (vacation & sick leave) – min of 12 days per year, accrued accrue at a rate of approximately 1.84 hours per 40 hours worked.
• 401k with up to 6% employer match
• 10 paid holidays per year
• Health savings accounts, healthcare & dependent flexible spending accounts
• Employee Assistance program, Employee discount program
• Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance.
• For Colorado employees, Conifer offers paid leave in accordance with Colorado’s Healthy Families and Workplaces Act.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees