Director of Clinical Denials Management and Hospice Audit
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About The Position
The Director of Clinical Denials Management and Audit supervises a team of RN/LPN clinical reviewers as well as Support staff managing all areas of clinical claim pre and post audit, appeals submission, and reporting to Palmetto in response to ADR's/TPE's/RCD processes across the enterprise HH and HO branches for all payor types striving to minimize lost revenue. Conducts analysis on denials and appeals and identifies trends that present process improvement and revenue protection opportunities. Monitors state and federal regulatory agencies to maintain up-to-date knowledge on changing rules and regulations affecting NCH denial prevention and management practice. Supports the development of standard operating procedures and plans, training, and ensure the denial department provides subject matter expertise around clinical denial management. This position will also support detailed level reporting and analytics, clinical appeals, root cause analysis, and address identified trends in reasons for denials. Work in partnership with HH & HO operations and customers to drive improvement in the quality of services delivered to patients.
